How do we know we are making a difference?

Capturing impact, change and improvement

Dr Edana MinghellaIndependent Consultant

What this talk is about

• Why does looking at impact/evaluation matter?

• How do we know we are making a difference?• Stories as a way of looking at impact• Other methods• So, what difference does it make? Findings

from evaluating compassionate care• Costs?

Why does evaluation matter?• Improvement• Share good practice• Improved staff morale • Sustainability• Challenge: if it’s not doing good, why are we doing it?• Why should people fund/commission/value your

service?

What do we want to know?

• Good outcomes• Good experience• Safe• Cost-efficient• How can we do better?

How do you know something is making a difference?

“To change an organisation, change its stories”Gary Hamel

From the Francis report (1)...

“You could hear the buzzers sounding. After about 20 mins you could hear the men shouting for the nurse, “Nurse, nurse” & it just went on & on. And..you would hear them crying, just sobbing, they would just sob & you just presumed they had had to wet the bed..”

From the Francis report (2)..

“I could not believe my eyes. The door was wide open. There were people walking past. Mum (96) was in bed with the cot sides up & she hadn’t got a stitch of clothing on... She would have been horrified. She was completely naked & if I said covered in faeces, she was. It was everywhere... It was literally everywhere & it was dried... It wasn’t new.”

A positive story...

Gordon was a new resident at a care home. Initially he seemed agitated and other residents found him disruptive. He would come into a room and start to take objects, such as lamps, apart. It emerged that one of his favourite pastimes had been to potter in his shed, taking apart and mending broken objects. The care home owner arranged with the family to relocate Gordon’s shed into the care home’s large garden for Gordon to potter in as before. He has now settled in happily.

Using stories to measure the impact of compassion(Dewar et al 2011)

• From patients and families• From staff• Informal observation to capture good practice

and feed back to staff.• Focus groups to explore staff and patient

perceptions of ideal care.

Other evaluation methods

• Qualitative

• Formative

• Quantitative

• Summative

Example of a person-centred questionnaire: CARE : Consultation & Relational Empathy

How good was the practitioner at

• Making you feel at ease• Letting you tell your story• Really listening• Being interested in you as a whole person • Fully understanding your concerns• Showing care and compassion• Being positive• Explaining things clearly• Helping you to take control• Making a plan of action with you

What difference does it make?Improvements after measuring compassion

• More caring conversations• Flexible, person centred risk taking• Feedback• Knowing you knowing me• Involving, valuing and transparency• Creating spaces that work

Leadership in Compassionate Care Programme Report 2012

What about cost?Three types of cost associated with compassionate care: 1. Money 2. Time 3. Strain

“In the end, a health system that gives compassionate care is a health system that is giving safe and high-quality care. It’s a health system that’s

giving good value for the resources that are expended.”

(Harvey Fineberg, Institute of Medicine, USA).

Sharing findings

• Feedback to people living with dementia• Report in• Report up • Report out• Share learning with other services• Identify critical success factors – what made

this work?

Don’t forget the little things....

EDANA MINGHELLAINDEPENDENT CONSULTANT

edana@minghella.com