As Clinical & Service Change Programme Manager for NHS Dumfries & Galloway, having responsibility for delivery of an extensive two year programme of “on the ground” changes, I would like to share something with you as we start out on our journey of change.
I am not going to go into any detail on why we need to change as we all know the demands on our health services will continue to grow, we all know that we have a responsibility for own health and the health of our family, we all know that resources are scarce. Yet, last week, a member of staff enlightened me to the fact that they “dinnae dae change”
That got me thinking, what if none of us “did change” what would that actually mean.
We are in an enviable position in Dumfries & Galloway as we are about to embark upon building a new state of the art hospital, designed for optimal benefits for our patients and our staff. The new hospital will be ready to take its first patient at the end of 2017. We are also about to integrate Health & Social Care which will bring great opportunities. Very exciting times for us indeed.
However, lets take a sneaky peak at what the future may look like if we all stood still ….
Nothing was altered, nothing was done differently…..
Services continue to be scheduled based on a traditional working week (Monday – Friday – 9 am to 5 pm)
Patients continue to be admitted to an acute hospital as there are no alternatives available in the community setting
No new roles developed, appropriate skill-mix introduced, or integration of teams.
Technology was ignored
The result would be mayhem, with the likelihood that the new hospital would be doomed to failure before it even opened its doors and our community services saturated. This does not mean for one minute that our staff would not be working extremely hard to provide high quality services in the future but they would be very much up against it if we all stood still and didn’t do change.
Our team have been talking to staff to find out what change means to them and encouragingly we have had comments ranging from
“I fully Support Change”
“I find change exciting”
“We need change to survive”
“It’s necessary”
“I am just no techy!!!”
Here at NHS Dumfries & Galloway, the Clinical & Service Change Programme Team will continue to build upon the great foundations that already are in place, working closely with staff, listening, supporting and facilitating the necessary change.
Change is challenging, it is hard work, but it will be worth it!!
Look out for further information coming shortly and we will keep you posted as to how it is all going….
Stephanie Mottram is Clinical & Service Change Programme Manager for NHS Dumfries & Galloway
When I took up my post as an Occupational Therapist, within the Mental Health Substance Misuse and Learning Disability Service as a new graduate, I was unsure what to expect!! Having had a placement within the service I was familiar with the client group and the team however coming into this as an OT is very different to being a student! And my first initial thought was ‘what will I be doing as an OT?’
This is where the Home Based Memory Rehabilitation (HBMR) programme comes in! First suggested to myself and Corinna Sidebottom (OT, who started at the same time as me) back in 2012 as a possible piece of work we could develop within the service, who knew the success this would have?!
HBMR was originally developed in Belfast City Hospital in 2007 by Advanced Specialist OT Mary McGrath. It was developed as part of the cognitive rehabilitation approach for the treatment of people with acquired brain injury; however was found to be equally appropriate for the rehabilitation of cognitive deficits, including memory problems due to early stage Alzheimer’s disease.
It has been recognised that the main approach to helping people with memory difficulties to engage within their activities of daily living is to try to find ways to compensate for impaired memory, through memory rehabilitation strategies.
The idea of cognitive/memory rehabilitation interested me – we often associate rehabilitation with the likes of having had a broken bone and regaining the function within the specific limb, but we don’t commonly associate this in relation to Dementia (or at least, I didn’t!).
Cognitive rehab is defined as an individualised approach which should focus on real-life, functional problems a person experiences. Central to this is an understanding of the person’s strengths, abilities and deficits from a holistic approach, which as a profession, incorporates our core beliefs.
So what exactly is the HBMR programme? And how as new band 5s, were we going to develop this and pilot it within our service?
After various meetings we developed a modified version of Mary McGrath’s programme and we were then ready for a 6 month pilot.
Our HBMR Programme
The HBMR programme is a 4-6 week programme, delivered to the client, in their own home with caregiver/family support where appropriate. The pilot programme consisted of 4 sessions:
Remember where you have put something
Remember what people have told you
Remember what you have to do
Remembering people’s names and coping in social situations
Each session covered a range of memory strategies such as a memory book, memory board, post-its, safety checklist, using a calendar, medication checklist to name a few. These are all things any one of us could use within our daily lives to remind us of daily tasks.
The key to the programme is the structure and repetition of emphasis placed on the strategies and so each time a new session is delivered, all previous strategies are revisited to ensure the client is using these and is confident in doing so. It is this repetition that encourages new learned behaviours within people with early stage memory impairment and creates the habits that are more likely to be remembered as memory loss continues.
HBMR Programme – Pillot Results
Following our 6 month pilot, we compiled our evaluation – which in my opinion not only demonstrated the effectiveness of HBMR but also highlighted that people with early stage Dementia, can learn new skills!!
The graph below clearly demonstrates that following completion of the programme, at 3 month review there was a significant increase in the number of memory strategies clients were using. And as a result, a slight decrease in the number of reported memory difficulties they experienced.
Our Success!
Since completion of our pilot we have been working on promoting HBMR and how we can further develop this.
A key highlight of the whole process for me has to be winning ‘Best Community Support Initiative’ at Scotland’s Dementia Awards in Glasgow. Although probably the most daunting, as this involved making a small speech!!
Our poster has also won at national events and was displayed within the poster presentation at last year’s Alzheimer Europe conference.
We are currently looking at how to develop the programme, with a view to sharing this locally and nationally. Since pilot completion, we have reconsidered the session topics and we have now created additional areas we feel are important to cover. The programme still takes place over 4-6 weeks however now covers the following areas:
Remember your priorities
Remember what people have told you
Remember what you have to do
Remember people’s names and coping in social situations
Remember to keep your brain active
Remember your bearings
We are also considering other possible ways to deliver the programme such as the use of technology.
We have also been looking into the branding of the programme and are looking to have our resources and manual ready within the next few months and as mentioned, we hope to share this both locally and nationally!
I am probably very bias about the programme as I have been involved from the beginning! but I hope reading about the effectiveness of HBMR, has encouraged you to think about the ability to learn new skills in early stage Dementia and how this may impact on future practice…..after all – Dementia is everyone’s business!!
Emma Coutts is an Occupational Therapist with the Mental Health and Learning Disability Service at NHS Dumfries and Galloway.
Love it or hate it we have all heard of social media sites such as Facebook and Twitter. If you do use social media you will definitely have heard of and even participated in the ‘bare face selfie’ or the ‘ice bucket challenge’ successfully raising awareness of specific conditions and increasing donations for certain charities. With this in mind, our speech and language therapy team decided to create our own department Facebook page and Twitter account in order to raise awareness of the specific speech, language, communication and swallowing needs our service users encounter and how this impacts on their lives. “How hard could it be?” we naively thought.
Several hours later the job was done and, although it was slightly harder and time consuming to do than we initially thought, our reason for sharing this experience is because we could not have predicted how successful this venture has become. If you aren’t already familiar with us, we are the small(ish) adult team made up of speech and language therapists (SLTs), SLT support workers and one A&C based at DGRI and the Galloway Community hospital. So for a small(ish) department, you can understand our excitement at the fact that we currently have over 100 Facebook and twitter followers and this number continues to grow. So we’ve come up with four reasons why we believe the use of social media in professional practice can be a positive experience.
1. If we can do it then anyone can.
I have already hinted that it was initially harder than we thought but that’s because the social media skills within our team were (and still are) pretty limited. So if you’re in a similar position, then here are a few pointers as to how we went about it. Our first step was to check in with D&G NHS Communications department to make them aware of our plans and gain advice as to how best to do this in a way that would not get us sacked or struck off the HCPC register. Joke! (I think….). The next step was to sign up to Facebook and Twitter using our generic NHS email account. For Facebook, we followed their straightforward online instructions on creating a business page (we had to google it!). The admin section allows for each SLT and support worker to be involved in managing the page and posting information. This was important to us, not only because it is less time consuming than one individual being the sole person responsible, but because we all have our own particular areas of specialist interest. (It means we can post out information that is relevant in all professional areas within speech and language therapy). We then linked our Facebook page to our Twitter account meaning our Facebook posts would also be tweeted and vice versa, saving even more time than trying to manage the two accounts. Twitter is somewhat easier and anyone with an email address can create an account.
2. Raising our profile.
Our professional body, the Royal College of Speech and Language Therapists (RCSLT), have been involved in creating a campaign called Giving Voice. The aim of the #GivingVoice campaign is to raise the profile of our speech and language therapy profession and in their words “demonstrate SLTs unique value and evidence of our efficiency and value for money in a time of financial constraints”. Very important stuff that every NHS department can relate to. We do this by sharing posts and retweeting from the relevant larger organisations social media sites such as the RCSLT, Chest Heart and Stroke Scotland (CHSS), Alzheimer Scotland, Parkinson’s UK, British Voice Association, among the many other organisations where speech, language, communication and swallowing difficulties can be a symptom of the associated medical condition they represent. But the more exciting part for us comes when trying to think up our own ideas to raise our profile.
Remember I mentioned the social media ‘ice bucket challenge’ campaign earlier? Well you have our permission to have a good laugh at this video we posted on Facebook and Twitter with the very good intention of raising awareness of our role in supporting people with communication and swallowing difficulties as symptoms of Motor Neurone Disease:
Definitely think our friends from domestics enjoyed this more than us!
3. Health Promotion.
Using social media has even inspired us to get creative in our approach to health promotion. A recent project at the beginning of this year was for World Voice Day, 16 April 2014. Approximately a third of people working in the UK depend on their voice to do their work. The British Voice Association estimates that the cost of voice problems (dysphonia) to the British economy is approximately £200 million a year. Not including the impact dysphonia can have on general health through associated stress and depression from potential loss of work and social isolation. We created a social media blog and video to raise awareness of the importance of our voice for work and when and how to seek help early. We uploaded the social media video on to YouTube and shared it and the blog with DGhealth and our followers on Facebook and Twitter. Over 600 people took the time to engage in our World Voice Day social media campaign. It’s hard to think of any other more effective way to reach so many people in such a short space of time
Social Networking
Social networking can be an innovative way to share your practice based evidence directly with the people and organisations that will be most likely to benefit from it the most. As part of NHS DG dementia champion’s project, Rebecca Kellett, our SLT #dementiachampion, created the ‘communication and mealtimes toolkit’. She has since been invited to present the toolkit at both the RCSLT and Alzheimer Scotland day and also at the European Alzheimer’s Conference. The slide below demonstrates some of the Facebook posts and @SLT_DG tweets highlighting these exciting opportunities:
But before you think this is all about blowing our own trumpet (!) – If you look more closely at the examples given, can you see the use of # and @? The use of # ensures that anyone searching twitter for information on dementia, for example, will find this tweet. The use of @ means you are directly ensuring any relevant organisations or person’s will receive this information via their twitter notifications. And if you are really lucky, as we were in this example, then hopefully these people/organisations will retweet your message. Alzheimer Scotland retweeted the link to the toolkit to their 10,000 or so followers meaning that many carers across Scotland are now aware of this practical and useful resource for the people with dementia they are caring for.
So as we are drawing closer to the end of this blog maybe you are now hopefully feeling the love for social media a bit more? And maybe even inspired to give it a go if you haven’t already? I should say at this point that we don’t have access to these social media sites through the NHS unless requested and rightly so. But this is something that we are all happy to do out with working hours because it really doesn’t take up too much of our own time. I guess this is also a good time to say, if you are thinking of giving this a go, then stay professional at ALL times. There is no denying that the use of social media is open to abuse; no one wants to know what you are having for your tea. I keep my own personal social media accounts for this more personal information (and even then people really don’t want to know what I’m having for my tea). There is guidance on the use of social media on the intranet that you can refer to if you’re not sure what acceptable use is. You don’t even have to do what we are doing and create a department account; many people within NHS Dumfries and Galloway have their own professional social media accounts. And lastly, you don’t even have to do daft things like tipping icy cold water over your head to create interest. The example below shows how one wee tweet, every now and again, can go a long way.
We tweeted a happy world voice day message to @kendonaldson, Associate Medical Director, Renal Consultant and dghealth guru, who replied and retweeted our message. This then led to Paul Gray (CEO, NHS Scotland and Director General Health and Social Care, Scottish Government (if you didn’t already know)) joining in the conversation and retweeting also. Result!
The Office of National Statistics suggests that eight out of 10 adults in the UK now use the internet on a regular basis. If you haven’t already used social media to raise your professional and service profile, then we would highly recommend it. If you have done so already, then find us, follow us, like, share and retweet us, and we will repay the compliment. We can stay stronger through technology.
Pictured from left to right is Kim Harkness, FairyBodMother. Jade McIntyre, Fitness instructor. Laura Lennox, Speech and Language Therapist and Lynsey Swales, fitness instructor. Thanks again to FBM fitness academy and all the Fairy Bodlings who participated.
When Albert Einstein was asked his New Year’s resolution he, now famously, said “Learn from Yesterday, Live for Today, Hope for Tomorrow”.
It’s a new year and, as we move from the last few weeks of the 4 year ‘Putting You First’ (PYF) change programme towards the integration of health and social care, it feels like a good time to ‘learn from yesterday’.
It is nigh on impossible to pick up any national strategy, policy document or guidance on health and social care without coming across the phrase transforming health and social care services.
Here in Dumfries and Galloway, PYF has set us off on this journey of transformation; four years of developing
New ways of working
New thinking and
New partnerships between Communities, Carers, the Third and Independent Sectors, Dumfries and Galloway Council and NHS Dumfries and Galloway.
Transformational Change
There are good past examples of where we have successfully delivered transformational level change in Dumfries and Galloway, however, the scale at which transformational change is required in health and social care today is unprecedented. It is complex, requires a significant level of commitment and resource to achieve and takes time to deliver.
Impacts of transformational changes are often long term and non-linear. This means it is challenging to evaluate and demonstrate impact. However, an increasing focus on demonstrating ‘outcomes’ in the future rather than inputs and outputs and the achievement of short term goals will help to address this.
Partnership Working
PYF worked around a key principle of broad partnership working enabling a truly ‘whole systems approach’ between health, social care, housing, the independent sector, the third sector and communities.
“The experience of partners working together across all sectors through PYF has created a real momentum. Providers involved in meetings and tests of change have experienced a real difference for them personally – they say they are better informed, feel more engaged and, best of all, have become to feel more like real partners, rather than just contractors. Where individuals from different sectors have worked closely together the change has been even more dramatic – attitudes have changed and partners have realised that they ARE BOTH working to create better outcomes for older people.” (Sue Newberry Scottish Care Associate)
Culture
Acknowledging and accepting the different cultures that exist within each sector is important. It helps develop our understanding of each other and respect each other’s values and beliefs. This cultural diversity can bring new and different perspectives to thinking providing us with a more multi-dimensional overview.
“There is no doubt that the work in the Annan Pathfinder project has improved our understanding of the challenges we face as a team and helped us to use the different skills and approaches to better serve the individual we are caring for. This change in attitude and culture can only be built from the groups of individuals in these teams working more closely together to realise the assets we have within each and every community. These more integrated teams are the key to a different, more person centred approach to care which emphasises the responsibilities of the individual and the community.” (Dr Neil Kelly)
Leadership
Whilst the continued support of the PYF Programme Board, Locality Groups, Work Streams and Enablers has been vital to the success of this change programme, what has been achieved has been as a result of everyone acknowledging and embracing their own unique leadership role within their particular areas of expertise and interest.
“We need to encourage ideas from all levels of the organisation and provide people with the opportunities, support and “permission” to take their ideas forward. Recognizing the unique contribution that every person plays in delivering improvements is key to success, and critical to the continued development of services, teams and individuals.” (Linda McKechnie, Service Development Manager)
Working Co-productively with Communities
New ways of working together with communities was a key element of successfully delivering change at community level.
“Encouraging people and communities to take ownership of services and assessing their own health and care needs empowers people. It supports people to understand the processes involved in planning and the constraints and demands placed (on) services. I think people like to do rather than be done to. Community integration, participation and planning as well as inspiring, collective and future thinking leadership are key for any future and successful integration in my eyes” (Suzanne McGarva, Pathfinder Evaluation Programme Lead)
Emergent Themes
All of the tests of change that have been undertaken have quite naturally fallen under one or the other of these four themes.
Developing Communities/Community Resilience
Optimising Technology as an Enabler
Integrated Ways of Working
Preventative and Anticipatory (Proactive) Approaches
“As we move towards health and social care integration, it is important that we consider the 4 themes and the tests within each of them. The learning from these provide a helpful source of information that could contribute to the development of the Health and Social Care Locality Plans with a particular focus on supporting the delivery of the 9 national integration outcomes.” (Mark Sindall, PYF Programme Manager)
What other people had to say about some of the work developing under these 4 themes
Developing Communities/Community Resilience “Time bank has given individuals a chance in their own communities, contributing to new skills, enhancing their social networks and community engagement and therefore having a positive feeling of self-worth.” (Action for Children)
“Time Banking makes me feel I’m still able to offer something even though I’m in my 70’s” (Time banker)
“Makes an awful difference having the (Hard of Hearing) service, I don’t know what I would do. I don’t drive; I just wouldn’t wear my hearing aids”. (Service User)
“Fantastic piece of work (Single Point of Contact Initiative – Falls Pathway) with real benefits for patient’s going forward.” (Scottish Ambulance Service)
Optimising Technology as an Enabler
“Feel more confident. Was having trouble sleeping before (telecare) installation but happy there’s a backup in place and it is a lot more comfortable at home now” (Service User)
Integrated Ways of Working
“I have certainly made use of the ideas team on the end of the phone when I have not been sure of how to manage residents’ behaviour. I have personally found that very useful to get support when I’ve needed it” (Care Home staff member)
“If we did not get the timely and co-ordinated support from the health and social care hub, we would really have struggled to manage at home.” (Service User)
Preventative and Anticipatory (Proactive) Approaches
“It’s good to know that there are people looking out for you and your health as people like myself are sometimes too busy looking after everyone else and tend to forget about ourselves.” (Carer) “‘I was suffering with anxiety and unable to concentrate. I was desperate and unable to cope….my life is better, much better now” (Carer)
“I am able to live in my own home which means the world to me”
“Through this discussion (Forward Looking Care Planning) my family is now aware of what I do and don’t want to happen to me”
“Once the nurse had visited, adaptations happened very quickly and we had been waiting months for this” (Forward Looking Care)
Hope for Tomorrow
Are we facing complex and challenging times ahead? – Certainly, but there is hope for tomorrow. As well as all of the learning from PYF, there are many other opportunities on the horizon that we can capitalise on to support us to achieve the level of transformation of health and social care in Dumfries and Galloway that will deliver long term sustainability.
“Innovations in technology and treatments offer opportunities to change the way in which care is delivered.” (Royal College of GPs Report – November 2014)
The integration of health and social care is another opportunity for us to further develop new models of holistic, person-centred, seamless, team-based care and support for people with chronic, multi-morbid conditions; focussed on improving outcomes and working to support every person in Dumfries and Galloway to achieve what matters to them.
To see some of the PYF work in action, please click on the link below
Vicky Freeman is Acting Head of Strategic Planning at NHS Dumfries and Galloway
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