25 / 04 / 2009
Yeovil District Hospital NHS Foundation Trust provides acute care for a population of around 180,000 primarily in South Somerset North and West Dorset, and parts of Mendip. Each year the trust has over 30,000 patients admitted as inpatients or day cases, more than 90,000 people attending out patients appointments and around 40,000 treated in accident and emergency. The trust employs over 1,800 staff.
Over a two-year period, the trust's iCARE programme has become central to how the trust operates.
iCARE stands for Communication, Attitude, Respect and Environment. Staff focus focus on these four key themes to meet and exceed the expectations of all service users, as well as shape how they work with each other. The ‘i’ stands for the individual and stresses that every member of staff has a fundamental role to play in delivering exceptional care.
iCARE was developed following complaints and conciliation meetings that highlighted poor standards of care for some patients and their relatives. Although patients were being seen and treated in line with national targets and external standards, there were areas for improvement, linked to leadership, interpersonal skills and behaviour, and the ability to demonstrate the 'human' face of care.
The issues raised by patients and families fell under one or more of the four headings of communication, attitude, respect and environment. Changing staff behaviour in these areas would fundamentally improve the experience for service users.
Developing the approach
This simple approach was developed by a senior matron and received an enthusiastic response from the trust's senior nursing team. They recognised the powerful tool that iCARE could become, in describing the key behavioural attributes for all healthcare staff.
As a result the trust's chief executive and director of nursing agreed that iCARE should become the central focus of the organisation's developing culture and strategy. The trusts set up a steering group to develop the approach including testing iCARE’s principles with different staff groups and the Patient and Public Involvement Group, and ensuring effective communication to all staff. This included:
- 'Discovery work' with patients and carers, underpinned the framework for engaging staff and delivering iCARE, to develop a baseline of current performance and help track progress over time.
- iCARE awareness sessions for all staff covering the principles behind the concept and the opportunity to explore how iCARE could influence their own area of work and responsibility
The key themes of iCARE had been developed from real experiences of patients and carers, who the trusts believed should also play a key role in developing the framework. The Patient and Public Involvement Group quickly became a driving force in their own right, helping to develop patient questionnaires that were completed on the wards every month.
Other stakeholders included:
- PALS officers - represented on the iCARE steering group and leading iCARE awareness sessions, using relevant patient stories to keep the focus of the project relevant and grounded.
- Staff - representatives from the facilities teams, allied health professions, nursing and midwifery, medical and admin and clerical, all sit on the steering group
- The University of the West of England - Professor Kath Ross also sits on the steering group, advising the trust on how best to developed and evaluate iCARE
Key milestones for rolling out iCARE include:
- November 2006 - the principles of iCARE were outlined to the nursing, midwifery and therapy steering group
- February 2007 - consulted the Patient and Public Involvement Group
- Summer of 2007 - secured the full support of the trust board; started pilot projects with patient questionnaires and follow-up actions based on feedback
- August 2007 - gained academic support from the University of the West of England
- September 2007 - project framework in place; public launch of iCARE at the Annual General Meeting of Yeovil District Hospital
The staff awareness sessions are the backbone for the project with all staff attending a session for 10-16 employees, from different staff groups and roles. The informal sessions last around two hours and comprise:
- introductory brief from the chief executive or director of nursing - outlining the importance of iCARE to the trust's board
- groups discussions - on how care is delivered at the trust
- focus and discussion on real complaints and how things can be done better
- examples of good care and ‘Magic Moments’ for patients and staff
- staff leave the sessions with iCARE@ydh badges or lanyards that provide a constant visual reminder that iCARE is the trust's common ethos
So far (to February 2009), 91 per cent of all staff have attended an iCARE session.
Following the training, the key challenge was continuing to turn negative service user experiences into positive messages around changing culture and behaviour. This was overcome in part by the positive approach and support of the senior nursing team.
Staff have been encouraged to give feedback after the training sessions on how they have changed their approach and their 'Magic Moments'. This has helped to maintain momentum, with prize voucher every month for the best feedback card.
Internal communication has also been key. A weekly iCARE update on all computer screens reminds staff about sessions and attendance numbers so far. Screens are also used to share examples of positive patient feedback around good communication, attitude, respect and environment
Results and next steps
Key indicators of iCARE's success include:
- Getting good patient feedback - this is captured through the iCARE questionnaires and shows that the focus on the four key areas has improved the patient experience
- Engaging service users - a relative involved in one of the original conciliation meetings that triggered iCARE, has played a key role in its development and is now an ambassador for the trust and chair of its Patient and Public Involvement group
- Influencing staff - regular staff feedback shows that iCARE has influenced how they work together and helped teams solve disagreements, and focus on how they can improve relationships
- Improved staff surveys - showing a more 'contented' workforce
- Award recognition - the trust has been named as one of the top 10 Healthcare Employers in the country in the Healthcare 100 awards 2008, sponsored by the Health Service Journal and Nursing Times, and supported by NHS Employers.
The iCARE programme now features in all the trust's strategic plans and awareness (and refresher) sessions are on-going for new and existing staff. These continue to comprise different staff groups to create new approaches and ideas.
The iCARE questionnaires are now routine in all clinical areas.
iCARE has become a key element of the trust's human resources strategy and managers are now using the four iCARE principles, to guide staff selection and highlight and manage poor performance. iCARE also features in all job descriptions.
J Serge Mootoo, lead for equality and diversity, firstname.lastname@example.org