Aim: To introduce a safe, quick person-centred check list, called the Handy Approach, to all teams in Community Health Services Tower Hamlets East London NHS Foundation Trust from 1 May – 30 June 2017 as part of a test of scale up.
Background: Multiple barriers prevent staff in Community Health Services (CHS) from asking what matters to the people receiving care. A person-centred, safe and easy to use checklist with five questions, called the HANDY APPROACH TO CARE was previously tested successfully in a highly functional team in Newham CHS. As part of scaling up this checklist it was introduced into CHS Tower Hamlets at a time when the service was undergoing change and where time to learn was limited by competing demands. The checklist’s five questions captures an impression of the lived life of the person receiving care. Components of care can be mapped on the hand starting with the thumb, to prompt teams in summarising information from five of the following core domains: Mental (cognition and consent), Physical (function); Social (setting) and Personal (what matters). The five questions are: Is B… able to remember what s/he did yesterday? Does B…. give us permission to be involved in their care? Is B… able to get out of bed? Is B… alone at night? What matters to B… when s/he is having a good day?
Why is this important to service users and carers? Person-centred care is the first step towards developing collaborative care planning in partnership with service users and carers. The work done by National Voices on a narrative for person-centred care has informed this project.
Tests of change: A social network strategy of in-reach through early adopters, was used for each PDSA cycle to test diffusion and promotion of the Handy Approach checklist into teams. A short version of the Team Development Measure was tested in the four Locality Teams.
Learning: Our work shows that the checklist can easily be introduced into busy contexts. However there were differences between teams in their ability to engage with adopting this approach, which correlated with findings from a simple measure of team development. Highly functional teams learnt more quickly and more team members engaged with the novel learning approaches. The HANDY APPROACH TO CARE is popular with teams and can easily be learnt in time limited contexts using the PDSA cycles described but only if organisational attention is paid to the mission of the service and to fostering mutual regard in teams.
Conclusion: This test of scale up confirms earlier work done in Newham Community Health Services. Learning can occur during periods of change if the training is adapted to the people (adult learning), the place (on site) and pace (short) of the workforce. The HANDY APPROACH TO CARE is safe, popular and easy to learn in 10 minutes and a four minute summary can be found on YouTube . The short version (10 questions) of the Team Development Measure can be used to identify strengths in teams.