Principal Investigator: Dr Alastair Ross

Lead institution: University of Glasgow

Award amount: £132,796

Improving Systems of Care for the Older Person (I­­-SCOPE)

Many care home residents have multiple complex needs which, when combined with funding and staffing difficulties, make the provision of safe, high-quality care challenging. Traditionally, interventions aimed at improving care have focused on staff behaviour, either through recommendations and enforcement from regulators, or through staff training based on clinical protocols. Often, these improvement efforts target discrete aspects of care. However, there has been less focus on the broader system interactions in care delivery, and it has been argued that interventions that fail to consider these interactions holistically are unlikely to significantly impact on quality of care.

Human Factors and Ergonomics

Human Factors and Ergonomics (HFE) is a scientific discipline which considers interactions between people, resources, the environment, work tasks and processes. In the context of care provision, it moves beyond a focus on staff training alone; instead it aims to increase the wellbeing of providers and clients by improving overall system performance. HFE techniques are recognised as an evidenced and coherent approach to patient safety and quality improvement, and have been adopted by the NHS as a means to prioritise the effectiveness of care and ensure clinical excellence.

Project Aims:

This study, led by Dr Al Ross at the University of Glasgow, is one of the first to systematically employ HFE theory and methods in a care home setting. The primary aims were: a) to support care providers in meeting the challenges of providing safe, high-quality care for older people and b) to inform the design and development of interventions aimed at improving health and wellbeing in care settings. In particular, the researchers were interested in how multiple care priorities ­­— for example dementia, medications, diet and nutrition, pressure ulcers, mobility, oral health, and quality of life  — can be aligned from an HFE perspective, approaching the work system holistically rather than focusing on discrete behaviours.

Methods:

12 care homes were recruited as part of an in-depth, qualitative study over 24 months. Data were collected through a range of techniques, including: shadowing staff during the delivery of care; semi-structured interviews and focus groups with staff and stakeholders; innovative engagement with residents and their relatives using emotional touchpoints; and the study of key documents such as clinical protocols and care plans. From these data, the team were able to investigate key issues pertaining to achieving successful outcomes — e.g. how clinical work is accomplished, how challenges are overcome, how tools and technology are implemented to support the provision of care, and how information is communicated.

Key Results/Outcomes:

Through in-depth analysis of these interacting factors, the research has generated clear findings from which recommendations for the provision of care will follow. These include:

  • The complex and varying needs and preferences of residents means that care homes are dynamic environments that pose many difficult priority decisions for the people working in them. As such, care work should be viewed as “inherently complex”. Furthermore, whilst some standardisation is important for the provision of high-quality care (e.g. in risk assessments), following protocol alone is insufficient when caring for many residents and their needs. Instead, the researchers suggest, multiple potential pathways to success should be identified, where possible, to enable carers to work more flexibly.
  • There is little training provided for key coordination activities, such as prioritising tasks, anticipating, responding to interruptions, and synthesising conflicting information, which are shown to be vital in everyday care delivery. There is a need for such training to be provided, perhaps in the form of simulated situations that mimic potential real-life scenarios.
  • Paperwork generally acts as a barrier to care. The move to electronic systems in many care homes could lead to more timely and efficient recording of information, and better care through the sharing of more accurate information. However, the benefits (and potential negative consequences) of this move warrant further investigation.

Following on from this work, the I-SCOPE team is now in the process of finalising publications detailing their results, and producing materials to support the application of HFE principles in care homes based on their findings. They also hope to secure further funding to fully trial their recommendations on a larger scale.

Members of the project team: Professor Lorna Macpherson, Dr Al Ross, Dr Andrea Sherriff (University of Glasgow); Professor Paul Bowie, Dr Linda Young (NHS Education for Scotland); Ms Heather Edwards (The Care Inspectorate); Dr Janet Anderson (King’s College London); Dr San Selveindran (University of Cambridge); Dr Debbie Bonetti, Dr Evridiki Fioratou, Professor Ruth Freeman (University of Dundee); Professor Belinda Dewar, Dr Tamsin MacBride, Dr Edel Roddy (University of the West of Scotland).