Just over a year ago, WCS Care embarked on a programme to roll out electronic care planning across our small group of homes. Now 10 of the 12 homes are using it. We've shared our experience widely, and been very open about the positive impact it's had on our care delivery: an extra hour per carer every shift has increased interaction, there's much more detailed and accurate recording, and transparency for relatives who can see the care their family member is having throughout the day. And once carers were up and running (mostly around an hour to learn it and a surprisingly quick single shift to get used to it) they reported being thrilled to lose the onerous paperwork that would bug the last hour of their shift.
You might be forgiven for thinking – as I did – that was the goal achieved, not at WCS Care! In fact, “we’d only just begun”
Early in 2017, with the system bedding down in the majority of our homes, our Director of Innovation and Delivery, Ed Russell, started to interrogate and analyse the mass of data we were accumulating. With 2 or 3 clicks of his mouse he could identify on a given day which homes – for example - had completed monthly reviews for their residents and which weren’t completed. With another couple of clicks He could also see which residents these were for in each home, and which care co-ordinators were responsible for them. Being an ambitious type, he decided to see this as an improvement tool.
The data was sitting there waiting to be used, and there were any number of areas to focus on. Ed’s first point was that managers don’t need ‘to do’ lists; organisational expectations for care and all the detail of how we've delivered it is already available through the electronic system. And Ed decided to start by focusing on one area: fluid intake.
In month one (April 2017) over 20% of residents appeared on the system to have drunk under the 1.5L daily fluid intake we set as an expectation. It's possible they were drinking more but not having it recorded, so Ed spoke to our managers who all agreed that if it's not recorded, it hasn't happened.
They also agreed that every resident should be on fluid watch. So Ed set up a monitoring system: at 3.30pm every day one of our senior delivery team checks each home and identifies the number of residents there who haven't drunk a sufficient amount. They then contact the home and ensure that either a reason is given or that the resident gets offered more fluids to bring them up to the minimum level.
The result, by the end of May, showed we were down to an average 4 people a day (out of nearly 500) who weren't drinking enough, usually for appropriate reasons (perhaps slept all day or are end of life). And because we have the data we can track falls and UTIs, and falls particularly have already decreased by 33% since we started.
Fluids was a pilot project. Ed now has plans for the team to start analysing a whole range of other factors which impact on wellbeing for our residents. Managers have the confidence and the outcomes from the fluids project to be motivated and understand how to tackle the next challenge (in fact they may even be asked to set this themselves!).
So, we introduced a system intending to make life easier for carers, and discovered that it enables us to directly and immediately influence daily practice and quality.
Incidentally, so far, the electronic care planning hasn't been a factor in the outstanding ratings we've achieved in over 40% of our homes, (because we hadn't rolled it out in the homes when they were inspected). And we've been discussing internally that what’s outstanding is that we can now evidence that our residents are drinking on average 400ml more per day than the minimum 1.5L. But to me, what's even more outstanding is that we can be instantly responsive to a range of factors that we’re now measuring, and we can influence practice hour by hour and achieve constantly raised expectations by questioning, engaging and communicating using the data our care planning system provides at the click of a mouse.
So, you can be passive, and think you're sorted, by introducing something new. Or you can be ambitious, constantly seek to exploit and expand the newness and discover you can keep on raising your care quality to a whole new level.
And because we’re WCS, and we have a leadership culture of questioning and learning, that's the route we chose. And I'm so proud and impressed with the delivery team that they've – yet again – shown how, just by getting in there and having a go!
So as I said, it ain't what you do, it's the way/time/place that you do it…