Event Blog: Salford Care Homes Excellence Programme – Event 3

On Wednesday 3rd October, we hosted the 3rd event in our Salford Care Homes Excellence Programme series.

We began the day with Haelo’s Assistant Director, Kurt Bramfitt asking the group to consider, why are we here? After a minute to consider their answers, we heard some fantastic reasons:

  • We want to help the care homes in Salford provide better quality care for residents in Salford
  • To provide a better experience for residents
  • To put infection control practices into place
  • To share ideas and innovations
  • To improve the quality of care

We hear all about Edna, Kurt’s Nan. She suffered from small strokes and so needed to go into residential care. It brings joy to Kurt when he knows that she is receiving good care.

Attendees were invited to get to know each other a little better by discussing what their very first job was.

This ice-breaker encouraged everyone in the room to talk to someone they didn’t know and learn something new about one another.

Handing over to Jo Evans, Senior Improvement Advisor at Haelo to reflect back on content from previous events.

Jo reinforced one of the key messages from the last event;

‘It is so important to learn from failure.’

Jo then looked back on why are we getting together at these events? She notes the importance of not just talking about care homes in an isolated way, there is a much broader system across Salford, encompassing many other people and organisations, that all work together to provide the best care.

Who are all the people involved in ensuring quality for residents in care homes in Salford?

It’s a community; bringing together all the different people we’re working with.

We also revisited the Glimpses of Brilliance. We often overlook the good things and what we’re proud of, and so it’s nice to be reminded of the good stuff going on every day.

This event is focusing on the tools and methods that can help you improve your care homes.

Jo began by introducing the 6 steps to improvement:

  • Set your direction
  • Understand the problem
  • Develop ideas for change
  • Test out your ideas and review
  • Put it all together
  • Share your learning

Jo shares a video of a great example of a care home that has implemented a change. Pills: The Medicine Review Project.

Reflecting on the film, attendees have some great observations of what the film is about:

  • Making improvements to processes to free up time for staff to provide better quality of care
  • Empowering patients to make their own decisions about medication
  • Involving families in the process
  • Holistic care approach- putting the patient in the centre

We then move on to revisit the topics of interest from the last session and confirmed that we will be focusing on just a few of these today:

  • Quality of handover between settings
  • Care planning and risk assessments
  • Organisational culture/leadership and management
  • Nutrition and fluid management
  • Infection prevention and control

Participants were invited to self-select a topic they wanted to focus on for the rest of the day and sit at the appropriate table.

They are then asked to brainstorm the problems and issues in their own care homes, relating to the chosen topic on that particular table.

Each table was given 60 seconds to each feedback.

Nutrition and hydration:

  • Each has different systems within the care home
  • Time that residents take to eat can impact on wider staff time
  • In some homes there is technology, but in some its still paper. So when there are separate systems for food and for care, this can make things more difficult
  • Some of the documentation is so different but the training for how important nutrition and hydration is key

Care planning and risk assessment:

  • The main challenge is time, carers need to know the importance of the paper work of care planning and risk assessment
  • Time is also taken up with externals in the care home
  • Do the staff see that the recording is important? When Vs giving resident actual care its often hard to get the balance

Leadership and culture:

  • Link between management and leaders. Trying to work out what is leadership. What are the barriers in leadership?
  • Often having to be reactive instead of proactive
  • People are under external scrutiny, which perhaps make them more cautious
  • The manager is not the only leader. Building confidence in other people. We need to develop leaders and have resources for them

Infection prevention:

  • Staffing within the care homes can have a big impact- staff turnover
  • Education and training for staff
  • Important to look at the same processes across care homes
  • Need to look at isolation

Once we’ve looked at the challenges and what’s important, it’s often hard to follow the logical steps and identify the 1 thing to focus on. Which is why the next section of the event focuses on how to set a good aim statement, writing a single improvement aim

Criteria for a good aim:

  • Specific
  • Measureable
  • Timely

Kurt takes us through a good aim vs a bad aim, showing us some examples along the way.

Bad aim – we will improve care planning and risk assessments

Good aim – 95% of new residents will have a completed falls risk assessment and documented care plan within 24 hours of admission to our care by March 2019.

Hayley Moore, Inspection Manager from the CQC introduces the next session. Hayley reinforces that these sessions are a safe space for learning and development.

She notes the importance to involve staff in learning from an incident. If they understand the methodology they will be able to apply it moving forward.

Back over to Kurt now, who asks attendees to attempt to write an aim for one of their problems.

It’s not easy to write a really specific aim. The broader it gets, the more diluted it gets, and therefore harder to succeed.

Kurt takes us through some more methodology to help us understand how we can begin to draft our aim; often what we perceive to be the problems is a crisis.

We need to increase our leverage for improvement and not just firefight. We need to understand the data and what patterns are there.

The key to solving a problem is to first truly understand it.

Kurt introduces the room to The 5 Why’s…

One way to identify the root cause of a problem is to ask ‘WHY?’ 5 times. When a problem presents itself, ask ‘why did this happen?’

Kurt now asks attendees to pick a problem statement, perform the 5 Whys and then review the root cause.

We next move on to data, and how we can collect it.

If we’re going to measure improvement, we need to understand what is happening over time.

Ultimately what we’re trying to do is to improve the reliability of our processes. You need to build a measurement strategy to look at your key processes and interventions, to see if there is any variation.

We need to get rid of the anecdotes, and just use the data.

The afternoon kicks off with Jackie Burrow, Assistant Director of Nursing, Integrated Care Organisation, as we begin our focus on safer handover.

Jackie reinforces that there are lots of opportunities here and we need to utilise this protected time. We have a huge resource to rely on as part of the ICO.

This is the start of a conversation, with something to build on.

We then go back over to Jo to frame the questions we need to ask when looking for good practice:

  • Who is your customer?
  • What matters to them?
  • Are you adding value?

We should also be looking at waste. Jo gives us some common examples of waste: talent / skills, errors, movement, repetition, over-production, time and transport.

The next part of the session splits participants into 3 different rooms:

  1. Process Map
  2. Data
  3. Story time

There were a lot of similar discussions happening in each of the groups- which shows there are a lot of the same issues.

It is also noted how invaluable it is to have a wide range of professions here because it highlights the broad spectrum of people that can work with individual patients.

In the final session of the afternoon, we looked at how we can develop ideas for change.

What changes can we make that will result in an improvement?

The next activity asked teams to come up with one problem related to their process that they would like to develop some new ideas around.

We were introduced to SCAMPER, a checklist creativity technique.




Modify, maximise or minify

Put to other uses


Reverse or rearrange

Participants used the tool by asking questions about existing products, processes or services using each of the 7 prompts. These questions can help you come up with creative ideas for developing new concepts and for improving current ones.

We finished off the day by asking:

What are you going to do next?

What’s your individual CTA?

The day ended by showing Alive Inside: Henry’s Story. An inspiring film showing the huge impact often small changes can have to individual’s care.