The original intervention and how it evolved
| Intervention component | Original/added later | Ways in which the component were implemented | Extent to which component was used |
|---|---|---|---|
| NHS Safety Thermometer (NHS designed and owned online tool for collecting process and outcomes data) | Original | Implemented with first cohort and offered to all of second cohort, then replaced by Safety Cross and Monthly Mapping tools (see below) | 66% of first cohort homes tried the Safety Thermometer. About one-third input data |
| Active involvement of staff, residents and relatives in sharing data and co-creating improvement solutions | Original | Staff initially slow to share data but became enthusiastic as project progressed. Residents and relatives hardly actively involved at all but project details and data displayed on public notice boards in most homes | Fewer than 10% of first cohort homes shared Safety Thermometer data. Eighty per cent of homes used the Safety Cross and displayed this for staff, residents and families to see. Sixty per cent displayed graphs from the Monthly Mapping tool |
| Training for care home staff in improvement methodologies | Original | Quality improvement training was provided initially by the NHS staff, then adapted and provided by the improvement team | All homes took part in training. In first cohort, this was chiefly home managers but in subsequent cohorts some senior carers also attended |
| Participants able to deliver the training to peers (train-the-trainer) | Original | Formal train-the-trainer model was not implemented though local advocates (‘champions’) were encouraged to roll out learning to others | Champions were found to work well to spread learning informally |
| Intervention toolkit containing a compendium of evidenced-based interventions for each of the domains of the Safety Thermometer | Original | Toolkit with worksheets and information sheets developed | All homes received a hard copy and an online version. Unclear how much they were used by first cohort and then dropped as Safety Thermometer replaced by Safety Cross |
| Safety culture assessed using the MaPSaF tool at three time points (before, during and after PROSPER), using the tool to understand and address barriers to change | Original | MaPSaF revised and tested in different ways with various cohorts | Use not prioritised by the improvement team or by the homes. Small number of homes actively used it. Progressively more significant changes made to the tool for each cohort to make it more relevant |
| Communities of practice | Original | Three community of practice events held throughout project | Between a half and two-thirds of homes attended the events |
| Improvement tools and case studies uploaded to resource tool for peer learning | Original | Knowledge hub set up and documents uploaded periodically, mainly copies of things sent by email | 10% of homes signed up and none of them posted information |
| Ongoing support from improvement team including meetings, visits and telephone conferences | Original | Facilitators visited homes with varied frequency. During the intensive phase, some homes were visited monthly and others every 3–4 months. Group telephone conferences were not used | Some homes received regular support and others did not. Some homes reported that they had no contact with their allocated improvement adviser for 6 months |
| ‘Safety Cross' for displaying information about monthly incidents replaced Safety Thermometer (see above) | Addition | Used from cohort two homes onwards then also rolled out to cohort one | About 80% of homes reported using it |
| ‘Monthly Mapping tool’ using graphs with monthly data to track changes over time and compare averages | Addition | All homes were invited to provide data about the monthly incidence of harms. From cohort three onwards, homes were given access to an online tool | About 60% of homes provided some data. One-quarter used the tool regularly without prompting |
| Provision of resources such as information posters, certificates of training, mirrors to view pressure ulcers and other tangible resources | Addition | Resources developed ad hoc | Homes offered tools during community of practice and visits. Variable uptake depending on focus. Resources appeared to be highly appreciated |
| Provision of additional training beyond improvement methods courses, such as training in infection control and pressure ulcers | Addition | Twenty-six training sessions run | About 50% of homes participated |
| Coordination with partner organisations in the NHS | Addition | Varied by geographical area | Varied by geographical area |
| Monthly newsletter | Addition | Sent monthly to participating homes | Sixty per cent of home managers reported reading it |
Green=implemented as planned; Amber=partly implemented as planned; Red=not implemented as planned.
MaPSaF, Manchester Patient Safety Framework.