Transforming Community Services � Long Term Conditions baseline by dbmMp7v

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									Document to illustrate how the QNI baseline matrix has been used within Surrey Community Health to generate quantitative data in addition to qualitative data. Data has
been changed and anonymised, so the information displayed is included only to show how the tool can be utilised.

  Transforming Community Services – Long Term Conditions baseline assessment using The Queen’s Nursing
                                        Institute matrix 2010-11.
Summary:
An initial baseline assessment was undertaken, based on the ‘Transforming Community Services: Ambition, Action, Achievement –
Transforming Services for People with Long Term Conditions (Dept of Health 24 June 2009), and using the Queen’s Nursing Institute Quick
assessment matrix. An initial assessment of red, amber or green was made, and qualitative data was gathered as comments alongside each
score. The colour coded score was translated into a quantitative scoring system which was used to clearly display current achievements
against standards set, and benchmark current practice across localities (within rehabilitation services) and to display progress over time.
This assessment was conducted by representatives from community nursing across the organisation and will be repeated on an annual
basis until evidence based practice is achieved and consistently implemented.

Introduction:
The Transforming Community services (TCS) Long Term Conditions (LTC) work stream within Surrey Community Health (SCH) aims to
support the design and delivery of effective care, which enables people to stay as well as possible for as long as possible while being in
control of their own condition (TCS transformational Guide, Dept of Health, 2009).

We undertook a stock take of where we were against the basics (Getting the basics right – every time) and high impact changes (Making
everywhere as good as the best) to identify priorities for improvement, using the Queen’s Nursing Institute (QNI) Transformational Guide
Quick Assessment Matrix, Services for people with long term conditions.

How we used the matrix:
2-3 clinical leaders discussed each of the 43 action criteria across the 14 dimensions. This was followed by all members of the LTC work
stream discussing their self assessed scores and challenging to test the evidence that individual members of the group put forward. A single
self assessment score was then agreed by the group for each action criteria.

This allowed us to rate each action as a red (action required), amber (actions underway) or green (actions achieved) across ambition 1 –
“getting the basics right every time” and Ambition 2 “making everywhere as good as the best”.

Introduction of a scoring system:
A numerical scoring system was devised to compare progress in different areas of the guides and assess progress over time:
Red – ‘we need to do much more on this’ – actions required were identified (score 1)
Amber – ‘not sure where we stand on this OR some elements need more work’ – actions identified (score 2)
Green – ‘this is in place in our service’ (score 3)
                                                                                                   Surrey Community Health – Long Term Conditions TCS work-stream
                                                         Julie Sears, Clinical Audit Manager Kirsty Thurlby, Chair, Long Term Conditions Steering Group 19 April 2011.
Document to illustrate how the QNI baseline matrix has been used within Surrey Community Health to generate quantitative data in addition to qualitative data. Data has
been changed and anonymised, so the information displayed is included only to show how the tool can be utilised.
Benefits from application of the scoring system:
   The scores generated have been used to display current identified strengths, weaknesses and gaps in easy to view chart format.
   This visualisation has assisted in drawing up specific planned actions and monitoring their effect.
   Through regular re-assessment, progress in transformation of services and sustainability of progress can be monitored.
   Future projects can be developed based on the priorities identified.
   Other TCS work-streams including ‘Rehabilitation’ and ‘Acute care closer to home’ have now adopted the scoring system and charts
      so that best practice may be identified and shared across work-streams and common areas for development may be identified.

The charts found in appendix 1 give examples of firstly the overall picture, then the subset totals, and finally the individual score ratings.

For ambition 1, there are 20 criteria, giving a total possible score of 60. For example if the baseline score is 46/60 then 77% is achieved.
For ambition 2, there are 23 criteria, giving a total possible score of 69. For example if the baseline score is 48/69 then 70% is achieved.

Taking the Findings Forward
This stock take helped to identify clear priority areas that required development, which included: Technology, Partnership Working, Business
Readiness & LTC Management. Going through the process helped the group to jointly agree the future plan for work programmes including
identification of actions and expected outcomes. These priorities contributed to the foundations of developing our community nursing
strategy which focuses on developing services to meet new commissioning intentions, provide high quality and cost effective care.

Clinician and stakeholder consultations were also undertaken, the priority areas from the QNI self assessment matrix were used as
discussion areas for clinicians, senior managers, patients, carers and stakeholders to identify actions to be undertaken to develop the
community nursing service over the next 5 years.

From this methodology, the community nursing strategy for Surrey Community Health is now structured around these 5 key areas;
identifying a vision, measure of success (evidence of achievement) and recommended actions.

Conclusion
The TCS Transformational guides and the QNI self Assessment Matrix together with our locally developed scoring methodology has
enabled us to demonstrate an evidence based approach to reviewing and modernizing our services.

Surrey Community Health’s Community Nursing Strategy is now published and is based on evidence and professional consensus, which
drives quality, innovation and productivity as outlined within the TCS transformational guides (DOH, 2009). The QNI self assessment and
our locally developed methodology of presenting the outcomes will support us to tangibly evidence the change and achievements of the
strategy once work programmes have been implemented.
                                                                                                   Surrey Community Health – Long Term Conditions TCS work-stream
                                                         Julie Sears, Clinical Audit Manager Kirsty Thurlby, Chair, Long Term Conditions Steering Group 19 April 2011.
Document to illustrate how the QNI baseline matrix has been used within Surrey Community Health to generate quantitative data in addition to qualitative data. Data has
been changed and anonymised, so the information displayed is included only to show how the tool can be utilised.
 Appendix 1 – examples using fictitious data to show how charts may display findings: The aim is to achieve 100% over time.

                                   Chart to show overall score at baseline assessment on ambitions 1 and 2
     100


     90


     80


     70


     60
 %




     50


     40


     30


     20


     10


      0
           August 2010 1st assessment         2nd assessment                 3rd assessment                 4th assessment                5th assessment

                                                         overall score ambition 1      overall score ambition 2

When the overall score for ambitions 1 and 2 reaches 100%, this denotes that all responses will be green, and considered fully
implemented. Scores of 70% at outset suggest that community nursing is commencing transformation at a sound foundation level, and
trajectories may be set to assess and monitor progress over time.
                                                                                                   Surrey Community Health – Long Term Conditions TCS work-stream
                                                         Julie Sears, Clinical Audit Manager Kirsty Thurlby, Chair, Long Term Conditions Steering Group 19 April 2011.
Document to illustrate how the QNI baseline matrix has been used within Surrey Community Health to generate quantitative data in addition to qualitative data. Data has
been changed and anonymised, so the information displayed is included only to show how the tool can be utilised.




                   ambition 1 baseline rating                                                           ambition 2 baseline rating

                                             2
                                                                                                                                  3
                                                                                                          5


             8




                                                          10

                                                                                                                               15




The pie charts show an example of the overall composition of red, amber and green components that could make up the current score rating

                                                                                                   Surrey Community Health – Long Term Conditions TCS work-stream
                                                         Julie Sears, Clinical Audit Manager Kirsty Thurlby, Chair, Long Term Conditions Steering Group 19 April 2011.
Document to illustrate how the QNI baseline matrix has been used within Surrey Community Health to generate quantitative data in addition to qualitative data. Data has
been changed and anonymised, so the information displayed is included only to show how the tool can be utilised.

                  Chart to show an example of section scores estimated on possible baseline measure of ambition 1
                                         (red score = 1, amber score = 2, green score = 3)
  100


   90


   80


   70


   60
 %




   50


   40


   30


   20


   10


     0
          1. Knowledge &      2.Effective Health &    3.New services &        4. Access &        5. Care planning &      6. Information &      7. Education &
              planning         care partnerships         approaches            availability      case management            technology             training

Looking beyond the overall score for ambition 1, there is variation by component section identifying relative perceived strengths and gaps
and priorities for action planning.
                                                                                                   Surrey Community Health – Long Term Conditions TCS work-stream
                                                         Julie Sears, Clinical Audit Manager Kirsty Thurlby, Chair, Long Term Conditions Steering Group 19 April 2011.
Document to illustrate how the QNI baseline matrix has been used within Surrey Community Health to generate quantitative data in addition to qualitative data. Data has
been changed and anonymised, so the information displayed is included only to show how the tool can be utilised.

                                  Chart to show example section scores on initial assessment for ambition 2
                                               (red score = 1, amber score = 2, green score = 3)
  100


     90


     80


     70


     60
 %




     50


     40


     30


     20


     10


     0
            1. Local health    2. Effective health &   3. New services &       4. Access &       5. Care planning &     6. Information &       7. Education &
           needs & service      care partnerships         approaches            availability     case management           technology              training
               planning

The overall score for ambition 2 shows less variation but still clear vision of changes required to ultimately reach 100% across dimensions.

                                                                                                    Surrey Community Health – Long Term Conditions TCS work-stream
                                                          Julie Sears, Clinical Audit Manager Kirsty Thurlby, Chair, Long Term Conditions Steering Group 19 April 2011.
Document to illustrate how the QNI baseline matrix has been used within Surrey Community Health to generate quantitative data in addition to qualitative data. Data has
been changed and anonymised, so the information displayed is included only to show how the tool can be utilised.

                                                                                                      Ambition 1 individual ratings on initial assessment
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 score 1 = red 2 = amber 3 = green




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Each component of self assessment is displayed for ambition 1 as an example of how results may be visualised.

                                                                                                                                                      Surrey Community Health – Long Term Conditions TCS work-stream
                                                                                                            Julie Sears, Clinical Audit Manager Kirsty Thurlby, Chair, Long Term Conditions Steering Group 19 April 2011.
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                                                                                                                Each component of self assessment is displayed for ambition 2.
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                                                                                                                                                                                                                                                                                                          Ambition 2 examples of potential individual scores on initial assessment




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                                                                                                                                                                                                                                                                                                                                                                                     Document to illustrate how the QNI baseline matrix has been used within Surrey Community Health to generate quantitative data in addition to qualitative data. Data has




                                          Surrey Community Health – Long Term Conditions TCS work-stream
Julie Sears, Clinical Audit Manager Kirsty Thurlby, Chair, Long Term Conditions Steering Group 19 April 2011.
Document to illustrate how the QNI baseline matrix has been used within Surrey Community Health to generate quantitative data in addition to qualitative data. Data has
been changed and anonymised, so the information displayed is included only to show how the tool can be utilised.

                     Example chart to show how improving TCS QNI overall assessment scores may be displayed
                  between baseline measure and further assessments to show comparative progress across different
                                                    teams services or localities
  100


   95


   90


   85


   80
 %




   75


   70


   65


   60


   55


   50
                                            1st                                                                        2nd




                                                                                                   Surrey Community Health – Long Term Conditions TCS work-stream
                                                         Julie Sears, Clinical Audit Manager Kirsty Thurlby, Chair, Long Term Conditions Steering Group 19 April 2011.

								
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