Care home readiness: a rapid review and consensus workshops on how organisational context affects care home engagement with health care innovation

Abstract

Summary The NHS Five-Year Forward view recognises that the NHS needs to do more to support older people living with frailty in care homes. This paper presents the findings from a rapid review and consensus events that explored how organisational context affects uptake of healthcare innovation in long term care settings. Care home managers and front line staff, care home researchers, NHS commissioners and NHS practitioners participated in the workshops. The review found that uptake is likely to be better when contextual factors are addressed. Leadership and care home culture were important but there was a limited consensus about how to identify this or, for example, what kind of leadership made a difference. A few studies highlighted the importance of making sure that the priorities of care home and health care practitioners were aligned and establishing that care home staff had the resources and time to implement the change. Workshop participants agreed that the different contextual factors discussed in the literature were important and resonated with their experience. NHS services and practitioners had not however, structured their work with care homes to take these factors into account. Also discussed was the need to consider if NHS services understood how to work with care homes. In deciding how and when to allocate resources to care homes to support new initiatives, the NHS needs to consider carefully the organisational contexts and assess them appropriately. Based on the combined findings we suggest ten key questions for commissioners and service providers working with care home providers. Ideally these questions can be used prior to working with care homes. They can also help to structure reviews of uptake of innovations to enhance health in care homes. 1. Does this intervention align with care home priorities? Or are there other potential interventions that care homes identify as more pressing? 2. What evidence is there of senior management interest and enthusiasm for this intervention at organisation & unit level? Are they willing and able on a daily basis to take a leadership role in supporting the proposed change? 3. Do care home staff have enough “slack and flexibility” to accommodate the change into their current workload, is this recognised as core to their work? 4. How is change discussed (formally and informally) in the care home setting? Who needs to be involved in decision-making about what is being proposed and how it is implemented? 5. What are the recent changes or health related projects this care home has been involved with? 6. Is there a champion in both the care home and in the linked NHS service with protected time to help facilitate change? 7. What are the pre-existing working relationships between NHS services and care home staff and networks of care and support around the care home? ( e.g. GPs, visiting specialists, links with local hospital) 8. Could the intervention appear judgemental by signalling in a negative way that the care home needs to change? 9. How well do existing care home training programmes and work schedules fit with what is proposed? 10. Will care home staff have to collect and enter new data or is it held in existing systems? The report concludes by suggesting some strategies that might support how NHS practitioners and care home staff address their capacity and readiness to work together.