A Service Evaluation of Professional Visitors Rewarding but Requires Resource
Background
Hospices have traditionally been seen as experts in end of life care, but we also have expertise in volunteer management, data and digital and managing collaborative relationships with partners such as the NHS. One of our strategic aims is to share our knowledge and expertise.
Aim
The aim of this service evaluation was to quantify the amount and type of professional visits we host, where the visitors are from, how much time they spend at the Hospice and what feedback we receive.
The data will be used to inform discussion about how we manage visitors in the future.
Results
Department Visited
Which organisations are the visitors coming from?
Method
In April 2023 we began collecting data about professional visitors. Professional visitors were defined as people who attend the Hospice with the specific aim of learning from us about an area of our work. They are additional and distinct from the learners who attend our educational events and programmes.
We included virtual and face to face attendance. In April 2024 we summarised and analysed the first year of data and presented our results.
During the year we received a total number of 60 visitors, 74% were nursing or medical learners. 80% of visitors are observing practice with the intent of learning about psychological support, education provision, data and digital, physiotherapy, leadership and management, quality assurance, art therapy and social work.
A better understanding amongst generalists of symptom management
• Increased understanding of the nature and benefit of holistic care
• An appreciation of the need for forward planning
Improved working collaborations
The opportunity for patients being better informed about our services
Raising the profile of Princess Alice Hospice work
• Attract future palliative care workforce
Conclusion
As an organisation we recognise that we need to be supporting learning of our system and sector partners. We wish to continue to do this. The service evaluation allows us to highlight this aspect of our work and decide how to make it sustainable. We have subsequently initiated a review of the payments received via tariffs for different professional groups and raised awareness amongst staff of the positive impact of hosting Professional Visitors.
“Understanding antiemetics/pain relief. Understanding requirement of palliative care in the community. Great to hear about what it’s like to be a palliative care doctor.”
“The role of palliative care in supporting a huge cohort of patients with their quality of life.”
“Role of clinical nurse specialist. How hospices are run and funded. Communication and rapport
Professional role of visitors
“The different pathways by which people can be referred to and access palliative care.”
“Holistic care, patient centred ward rounds, how to diagnose and document death, how hospices work.”
“Understanding how holistic palliative care is and how important communication skills are in this specialty.”
Emily Sills – Medical Director; Jane Berg – Director Skills Knowledge & Research, Princess Alice Hospice.
Research Governance Support for Hospices A Pilot Project
Shannon Milne - Research Lead, Jane Berg - Director of Skills, Knowledge & Research, Emily Sills – Medical Director, Princess Alice Hospice, Becky Dilley - Research Delivery Manager, NIHR CRN Kent Surrey Sussex
Background
Hospices should comply with governance processes as stated in the UK Policy Framework for Health and Social Care Research1 to ensure delivery of high-quality research. We were awarded a grant from the NIHR to support the pilot of a regional hospice research governance role to support hospices in our region to expand their research activity and enhance governance procedures and practice.
Aims
Identify existing research activity and governance processes
Support development of robust research governance
• Identify mechanisms for ongoing research activity and governance support
• Assess impact of the role
Methods
• 18 hospices in our region were invited to complete an online questionnaire
• A visit by the Research Lead was offered to discuss governance needs/wish list (virtually/in-person)
Attendance at NHS R&D Forum: Wider Health and Care and Community Working Group3
• Develop relevant research governance support and resources based on results
Results
13 out of 18 hospices responded to the questionnaire:
Research Capacity
5 (38%) employ dedicated research staff (0.3 to 0.8 WTE)
• 2 of these posts currently unfilled
• 8 hospices include research activity in job role of a clinician (usually consultant, average of 1 hour per week)
Current research activity
(according to the Research Framework for Hospices4):
NICE defines research governance as:
“the broad range of regulations, principles and standards of good practice that ensure high quality research”. 2
Research governance policies and procedures
Conclusion
Hospices in our region are participating in research but most do not employ dedicated research staff and lack time and resource.
Governance processes vary between organisations.
A regional Community of Practice has been established in response
• Research governance resources including templates have been created for sharing.
What next?
“It is the carrying out of operational level activity that we struggle with”.
“Designing a policy”
“Don’t want to reinvent the wheel”
What would help?
“(We need) clear guidance about what processes and procedures… should be for different types of studies”
“We don’t have any dedicated staff resource for research so may be dependent on collaborative options”.
• Share research governance resources with hospices in our region
• Continued attendance at Wider Health and Care Community Working Group meetings for ongoing collaborative working Convene regional Hospice Research Community of Practice meetings twice yearly Utilisation of new NIHR Regional Research Governance Lead
Collaborating to Implement a Library Management System in a UK Hospice Library
Marianne Johnson, Library and Learning Resources Coordinator, Shannon Milne, Research Lead, Jane Berg, Director of Skills, Knowledge & Research, Princess Alice Hospice
What is a Library Management System?
In 2020, Health Education England, now NHS England - Workforce, Training and Education1, unveiled plans to consolidate 91 local NHS library management systems (LMS) and create efficient regional networks.
Koha2 was selected as the LMS platform ‘to provide NHS staff with a single, coherent national gateway to their trusted library and knowledge service’3
Our Hospice library requested participation and agreed NHS Knowledge and Library Services funding and collaboration with subsequent membership of our local NHS consortium.
Aims
To benefit and improve the library experience for staff whereby members can access and borrow items from the substantial regional NHS book collection and download eBooks purchased by the NHS
To allow NHS colleagues access to our specialist palliative care library collection
What did we do?
To work closely with the Koha software administrators, PTFS Europe4, to efficiently deliver the project
• To reflect a drive towards collaboration with healthcare partners, and workforce education in hospices5
May 2023
Programme of work commenced involving the Hospice Librarian, regional NHS representatives and PTFS Europe with online and face-to-face training.
September 2023
May 2023–June 2023
Hospice library print and eBook records were uploaded to Koha with extensive testing of uploaded data.
September 2023 –June 2024
Over 2,700 books were barcoded, scanned and digitally linked to Koha with considerable assistance from our library volunteers.
How will this help us?
• Increased use of and satisfaction with the Hospice library resources
• Online access for library members to manage accounts and view the regional book collection from electronic devices
Increased communication with library members via automatic book renewal and due-date email notification for tracking of the collection
• Targeting of our library budget spend by easy identification of our more popular resources and subjects
Sharing of our specialist palliative care collection with NHS colleagues
What’s next?
• NHS Workforce, Training and Education are rolling out Koha to all NHS healthcare libraries nationally – currently 75% of libraries are on board
Other non-NHS and hospice libraries will also be encouraged to join Koha in due course
Mentorship and support for Hospice library staff and volunteers to become more familiar with the new software
Training took place on the barcoding process for Hospice library staff and 3 volunteers.
July 2024
Rollout of the LMS at our Hospice following delays due to implementation lags in the London region and rollout of other
• PrintDOCS initiative will be added to Koha enabling users to request and share printed journals across the KSS region
Enabling Single Sign On (SSO) so that library members will be able to instantly view their library accounts
Supporting digital transformation in a UK Hospice
Celia Di Cicco, Head of Data, Information and Knowledge Management, Jo Hopkins, Head of Digital Platforms and Technology, Julia Russell, Director of Marketing & Comms, Digital and Performance, Princess Alice Hospice.
Background
In recent years, technological advancements have reshaped how clinical teams operate in the healthcare sector. The Topol Review1 offers recommendations for using digital skills to transform patient care and explores how to prepare the healthcare workforce through education and training to deliver the digital future.
The Review advises on:
How technology is likely to change the roles of clinical staff over the next two decades to ensure safer, more productive, more effective and more personal care for patients
What the implications of these changes are for the skills required by the professionals filling these roles
The consequences for training, development and lifelong learning of current and future healthcare staff
It is important to the Hospice’s Digital Team that we invest in digital skills to empower our clinical teams and support the work they do - this is necessary to ensure our digital transformation projects succeed and so that clinical staff can take advantage of digital efficiencies.
It is also important that clinical staff invest in their own digital learning and development so that they are best placed to deliver care in an increasingly digital landscape. Clinical and Digital Teams need to fit together like two pieces of a jigsaw puzzle.
Aim
Listen to the clinical workforce to:
• Find out what was working well
Understand the challenges staff were experiencing
• Anticipate future needs with regards to digital skillls requirements, technology and digital tools.
Method
In July 2022, the Hospice ran a digital workshop with 20 stakeholders from across the Hospice’s clinical workforce. Participants were split into small groups and an appointed facilitator collated discussion ideas. Responses were analysed using thematic analysis.
Results
Vital insights into the workforce’s confidence with digital tools and technology were ascertained indicating that the pace of change was too quick for the clinical workforce with nearly 40 separate comments relating to this. Thematic analysis provided the basis for development of a multi-faceted support programme.
Impact
Training feedback has been overwhelmingly positive with participants affirming their understanding via online feedback:
276 bookings onto the Digital Skills Programme so far, lifting the skills of 113 unique attendees
126 one-to-one support sessions delivered via the Embedded IT initiative
• 18 Tech Buddies actively supporting their teams in situ
Over 3000 tickets resolved by our IT Helpdesk each year
Conclusion
Verbal feedback on other initiatives, such as the Enhanced IT Induction and weekly Digital Tips, affirm the positive aspects of the program. Issue resolution via embedded IT, Tech Buddies and the IT Helpdesk further demonstrates the reach and impact of this multi-faceted approach.
Next steps
Engagement and impact of the workstreams is monitored quarterly and data will drive the evolution of each workstream, ensuring we adapt to the changing needs of the Hospice workforce using digital skills to transform patient care and explore how to prepare the healthcare workforce through education and training to deliver the digital future.
Workshop workstreams designed to address the digital skills gap and support transformation
IT Helpdesk: Provides speedy technical support and expertise via the online request form.
Cyber Security Drop-in Clinic: Offers face-to-face support to talk through any cyber risks that our staff or volunteers are unsure about.
Enhanced IT Induction: Aims to get our new starters off to a flying start with all things digital. Digital Skills Programme: Aims to further develop the skills of our workforce.
Digital Skills Development
Digital Tips: Our regular short, practical tips aim to help our workforce get the most of the digital tools at their disposal.
Embedded IT: Puts digital specialists on the ground with our clinical colleagues and provides support in the moment as required.
Tech Buddies: Peer support for staff and also providing a vital link, helping the Digital Team understand staff experience.
Data analysis in Microsoft Power BI tracks the reach and impact of the program’s workstreams:
Improving Assessment and Management of Delirium in Hospice Patients
Dr Isabel Brewster FY2, Dr Lucy Anson FY2, Dr Rachel Clingan ST6 in Palliative Medicine, Dr Aruni Wijeratne Consultant in Palliative Medicine. Contact: aruniwijeratne@pah.org.uk
Background
Delirium is common in the palliative care population and increases morbidity and mortality. An estimated one third of adults have delirium on admission to palliative care settings1. Only 13% of UK palliative care teams use a recognised tool to assess for delirium 2. The 4AT test is recommended by Scottish Intercollegiate Guidelines Network (SIGN) as a useful screening tool for delirium in hospice patients3. It is used on admission to Princess Alice Hospice as part of the initial medical admission clerking, and entered in the electronic patient record (EMIS). Early identification of delirium is important for treatment and potential reversal to improve patient outcomes.
Project Stage 1: Audit
Aims
• To raise awareness about the prevalence of delirium in hospice settings and the importance of recognising and managing this effectively
• To audit completion of 4AT as part of the medical admission clerking on the Inpatient Unit (IPU)
• To evaluate identification of causative factors and actions taken to manage these, if 4AT score indicates a possibility of delirium
• To improve documentation of actions if 4AT score significant
Methods
• 25 clinical records reviewed for patients admitted to IPU backdated from 31 August 2023 with retrospective data collection
Results
• Good engagement and uptake of 4AT completion with a possible delirium identified for over 1/3 of admissions, in line with literature evidence.
• However, a cause was not explicitly stated and there was no evidence of specific action taken to manage delirium.
What is the 4AT?
4AT is an assessment tool to screen for delirium and cognitive impairment (CI), comprised of 4 components:
• Alertness
• Abbreviated Mental Test 4 (AMT4)
• Attention
• Acute change over past 2 weeks
4AT gives a total score out of 12 indicating likelihood of delirium/CI:
• 4 or above: possible delirium +/- CI
• 1-3: possible CI
• 0: unlikely
Conclusion
Our audit replicated the evidence that over a third of adults have delirium on admission to a hospice. Ensuring an evidence-based screening tool is embedded within the medical admission clerking is essential for identification. However, this alone is insufficient for optimal management and documentation of actions. We have shown that by including clinical guidelines and facilitating individualised documentation, the medical team’s confidence acting on a significant 4AT score has increased, which will improve patient care and create meaningful change to patient outcomes. Project Stage 2: Quality Improvement Project - Plan, Do, Study, Act (PDSA)
Delirium Clinical Guide
Introducing an inclusive easy read booklet about our care
Mike Gerrard, Professional Lead, Senior Social Worker; Rosie Noble, Families and Carers Lead; Lizzie Leigh, Head of Communications, Princess Alice Hospice.
Background
Easy read documents use simple language and images to make information clear and accessible for everyone, including those with learning difficulties. We could not find examples of easy read guides about hospices and felt that the lack of more accessible information was a barrier to some people. In 2022 we set out to create an easy read guide about our Hospice and services.
Aims
To create an online and printed visual guide using easy read communication principles to share with carers and potential service users with learning difficulties, to help to:
• Allay fears
Lessen misunderstandings
Prepare potentially vulnerable service users for hospice care.
Results
‘’The easy read booklet is great when we’re visiting people in their homes, we’ve found it an excellent way to start the conversation about Hospice care and what that looks like.’’
Associate Director, Patient Care and Communities
Method
A working group was formed, including two colleagues with extensive professional and personal experience of supporting people with learning difficulties.
Easy read principles were studied and adopted1,2
Conclusion
Valuable insights for producing similar easy read literature in the future were generated. The guide has created wider interest around introducing easy read and plain English principles across more of our Hospice literature, as we work to champion equity of access to our care.
Incorporating user voice was important.
Two colleagues ran a focus group3 with seven adults at a learning disabilities day centre, to gain feedback at draft stage, considering practical and emotional needs. Feedback was incredibly valuable and incorporated.
The final guide was made available on our website in printed form.
Our approach to projects as a methodology
Konstantina Chatziargyriou - Head of Service Design & Continuous Improvement, Lizzie Leigh - Head of
Nigel Seymour - Chief Executive, Princess Alice Hospice
Background
A hospice introduces projects across teams and services that vary in size and scope. Projects enable implementation of beneficial changes set out in our strategic objectives1 To deliver on organisational strategic priorities, a scalable framework was required for colleagues to work towards continuous improvements and deliver projects successfully. It was agreed a defined methodology for approaching projects would help achieve this.
Aims
• Introduce a consistent approach to projects
Create agile processes to free up staff time
Create monetary savings and improve service
Results
• A more consistent approach across: Processes
Language
• Documentation
• More clear roles and responsibilities
Improved understanding of project justification
Better time management
• Use of agile techniques
• Empowered team members to lead projects
Better visibility of projects their progress, and overall capacity.
Method
In 2023, we implemented the new methodology, which was introduced to managers:
A step closer to a culture of continuous improvement, with less resistance to change.
“The approach enabled us to plan and prioritise to keep the things on track, whilst being agile and allowing the project to evolve throughout implementation according to the needs of the team, the wider Hospice and, importantly, our bereaved clients.” - Kelly
“As this was quite a big project, having a digital project plan in one place, which everyone could access, made a big difference and enabled us to work much more cohesively as a team, managing risks effectively but progressing efficiently.” - Sarah
What’s next?
The approach has been used for large strategic and small tactical projects. We have begun work on defining evaluation metrics that will measure the impact of introducing a methodology to all projects within the organisation.
Becoming an Environmentally Sustainable Hospice
Martin Osborn, Head of Operational Services; Junior Adjepong, Facilities Manager; James Butler, Health, Safety and Environment Officer; Sarah Tullett, Deputy Director Health, Safety, Environment and Business Continuity, Princess Alice Hospice
Aims
Background
The World Health Organisation (WHO)1 and National Health Service (NHS)2 recognise the adverse impact climate change is having on public health. While hospices will ultimately feel the effects of these health impacts, they will also inevitably be part of the Government and NHS net zero commitments to tackle climate change. This should drive hospices into taking serious action in developing their own environmental targets and becoming credible environmentally responsible organisations.
Overview of current environmental facilities initiatives
Identify areas where environmental performance can be improved
Increase awareness of the important role and impact hospice Facilities teams can have in tackling climate change
Energy Savings Opportunity Scheme (ESOS)6 Results
As part of the Palliative Care Sustainability Network5, developing the ‘Greener Palliative Care Award’
Looking ahead
We recognise we are only starting our environmental journey and that considerably more work is needed to collect relevant data, identify our actual ‘net zero’ journey, and implement further, meaningful, environmentally sustainable initiatives. Such future initiatives provisionally include looking at more effective energy, waste and water management, expanding our biodiversity, and further work with our Retail operations to identify environmental improvements.
