Developing a context assessment tool to inform NHS working with care homes

The NHS relies on the care home sector to support some of the most vulnerable and frail people in our population. The care home market is extremely varied so it is difficult to create a “one size fits all” approach to innovative NHS service delivery into the sector. Despite staff motivation and access to expert facilitation, innovations are not always taken up, for reasons that include:
• The roles, relationships and responsibilities of those involved (inside and outwith the home)
• Where they are located in the care home structure
• The “fit” of a health care intervention with the everyday workflow and priorities for care
• Organisational turbulence in terms of staff turnover and senior management involvement.
NHS services should try to understand from the outset how the organisational culture in care homes varies, as this needs to inform how they plan service developments and allocate resources. Based on our work (Goodman et al, 2015) we know that some care homes and some residents will require more from NHS services than others to achieve health related improvements in resident care. Assessing the context and culture of a care home, and its readiness to participate, could help shape how NHS services stratify health care to plan the type, frequency and allocation of resources to care homes and allow the impacts of new initiatives to be measured appropriately.
A recent review of care home specific culture assessment tools by a member of the team (AL) has identified up to 30 such tools. In Canada, the adaptation of the Alberta Context Tool (ACT) for use in care homes demonstrated the links between organisational context and how staff prioritise and review their work (Estabrooks et al 2011) . An attempt to use ACT with UK care homes reported, however, that care home staff found it difficult to use and there were analytical challenges. To provide the basis for the future development and testing of a tool that will assess care home readiness to engage with NHS services and innovation we propose two work packages:
Work package one (0-2 months): Building on the review work of Anne Laybourne and the findings from the OPTIMAL study, complete a rapid review of the evidence published since 2010 on context measurement in care homes.
Work package two (2-4 months): Using our existing networks and in collaboration with the Vanguard sites, convene three national meetings with care home managers and front line staff, care home researchers, NHS commissioners and providers of services to care homes. These will discuss the review evidence from work package one and using Nominal Group Technique build a consensus on:
a. The contextual factors that influence a care homes’ engagement with and uptake of NHS services and new models of working
b. Methods of recording, data sharing and review that are feasible for NHS and care home services to use to inform future joint working
The deliverable will be an agreed understanding of a method to assess care home cultural readiness for working more efficiently and effectively with the NHS. This knowledge product will in turn inform future evaluation of NHS input to care homes and form the basis for a larger project involving all stakeholders to test and refine a context assessment tool across and within the Vanguard sites.