Case study: Dorset Cardiac and Stroke Network Communication Inclusion Pilot Project 2009 - 2010
Deborah Slate, Service Manager, Community Speech and Language Therapy (Adults)
Summary The Communication Inclusion Pilot Project (CIPP) was designed to raise the awareness of NHS and local authority staff to the communication support needs of people who had communication disabilities following their stroke. It was targeted at all staff working in the stroke care pathway in recognition of the fact that all staff should have the skills to communicate effectively with the people they care for; 300 participated. The project supplied strategies for enhancing communication in verbal, written and environmental spheres. It required real changes to be made and involved people with communication disability in its design and delivery.
“I thought the Communication Inclusion Project was well organised, purposeful and as a result had a worthwhile response in content and enthusiasm from all who took part. Having been associated with stroke education for the past 7 or 8 years it was great to see a genuine sense of achievement in thinking through ideas. Very worthwhile.”
J C. Stroke survivor
Background The project arose from the Cardiac and Stroke Network PPI agenda in Dorset and specifically, in response to the stroke strategy requirement for the involvement of stroke survivors in care planning. It was recognised that those with a communication disability following their stroke would potentially be disadvantaged in this regard.
The aims were: to enable the effective and meaningful involvement of people with communication disability in care planning to deliver real change to service delivery, culture and process.
RCSLT - CQ Live 2016 Inclusive Communication - case study The project was funded by and delivered through the Dorset Cardiac and Stroke Network.
It was supported by: NHS Bournemouth and Poole NHS Dorset, Dorset County Council, Poole Borough Council Bournemouth Borough Council
and involved: The Royal Bournemouth and Christchurch Hospitals Foundation Trust Poole Hospital Foundation Trust Dorset County Hospital Foundation Trust Bournemouth and Poole Community Health Service Dorset Community Health Service.
In addition service users were recruited with the help and support of the Stroke Association Communication Support service and Speakability.
The project was funded for one year. April 2009 - April 2010.
Leadership
I took on the role of project lead as a result of an informal general conversation with the Public and Patient Engagement Lead at the Stroke Network about the inclusion of people with a communication disability and the role of the speech and language therapist. This prompted the project development; I was given free rein to both design and implement the project.
Objectives
To achieve the project aims, I identified the following objectives:
To enhance communication confidence on the part of the staff working in the stroke care pathway. The total number of staff working in the direct stroke care pathway, i.e. Acute and Rehabilitation Stroke Units and Community Rehabilitation Teams, in Dorset at the start of the project was estimated to be 600. To deliver an established training package in a locally sensitive way, in order to maximise both attendance and the motivation to make change. To ensure practical translation of the skills taught by requiring all trainees to “Make One Change” to their work place or work practice to bring it into line with the good practice in the training. To involve people with communication disability following their stroke in the development of the proposed “Make One Change” changes to ensure that they truly met need.
RCSLT - CQ Live 2016 Inclusive Communication - case study Process
Communication Access Toolkit The Communication Access Toolkit, a published training package, was selected as being appropriate for the purpose of the project. It had been developed by Connect, the Communication Disability Network and people with communication disability had been actively involved in its design. Contact Connect for further information.
The toolkit was both comprehensive and easy to deliver. It required the trained people to deliver the toolkit training, thereby ensuring a degree of consistency in approach.
Training champions Members of staff from each of the designated pathway points were nominated to become toolkit trainers. It was hoped that using team-based trainers would maximise the efficiency and effectiveness of the training.
Ten NHS Training Champions and nine Social Services Training Champions were nominated.
Evaluation panel People with aphasia volunteered to become members of the panel, which evaluated the workplace or work practice changes proposed by the staff. The panel was comprised of people with a range of communication disabilities and in some cases, also their carers.
Where a carer attended with the panel member, the carer was only allowed to voice their opinions on the proposed changes when all the panel members had had “their say”.
Results
Number of staff participating 240 members of NHS staff and 60 members of Social Care staff undertook the toolkit training. This represented 40% of the identified NHS workforce involved in delivering stroke care at the time of the project.
Products 104 changes to work place or work practice within the NHS stroke care pathway were identified.
Staff who already felt confident in their ability to communicate effectively with people with communication impairment have had their competence reaffirmed (15%) and those who did not feel confident reported improved confidence following the training (79%).
The people with communication disability who took part in the project as panel members reported feelings of increased confidence about taking part and huge satisfaction at having helped.
RCSLT - CQ Live 2016 Inclusive Communication - case study
"The communication project has been a great success. People given the training are so passionate about making one small change to help people with aphasia. These small changes may seem insignificant, but believe me, if you have communication difficulties, they are massive." F W. Stroke survivor
“A very good project. Inability to communicate is a very lonely place to be.” A.E. Stroke survivor
“Thank you for CIP project but half a stroke (club) and half a project. Thank you.” J.R. Stroke survivor
Celebrating changes made At the end of the project an Awards event was held to celebrate the changes that had been made. This included the presentation of a financial prize to the two best projects, as decided by the “Make One Change” panel members.
The winners were, Voice Buddy, an emergency call device which operates outside the home (East Dorset) and an aphasia-friendly discharge planning sheet (West Dorset).
Disseminating success
The project was presented at:
Dorset Nursing Best Practice Conference (March 2010) Joining Forces Stroke Conference as a poster (April 2010) British Aphasia Society Therapy Symposium (Sept 2010) National Stroke Conference in Glasgow (Dec 2010).
The project was selected as: Regional finalist for the “Support for Independence” category of the National Health and Social Care Awards 2010 Winner of the “best demonstration of delivering patient-centred care” at the 2011 NHS event “Clinical Leadership in Heart and Stroke the improvement story so far”.
Challenges
The delivery of a non-mandatory one-day training package during a period of significant clinical pressure. This was addressed by the emphasis on locally delivered team based training and the development of a condensed half day toolkit option.
The timescale necessitated that the champions were nominated rather than appointed. The champions for each area were nominated by their line mangers. The variations in their background, motivation and confidence as trainers lead to some unexpected, but
RCSLT - CQ Live 2016 Inclusive Communication - case study surprisingly beneficial, training dynamics where team members supported their communication champion by attending the training.
Medical staff, with the exception of one consultant and ancillary staff, with the exception of one Housekeeper, did not access the training. It became apparent that medical staff could not, by and large, afford the time to attend the training and the ancillary staff perceived it to be only for clinical staff despite assurance to the contrary. These challenges were not resolved within the time limit of the project.
Including a requirement to change practice as part of the training. It was very important that the project should be more than a training exercise if culture was to change. Staff were anxious about making changes and also about presenting them to people with communication disability.
Feedback after the event showed that both parties found the experience very rewarding:
“This is the best training I have done”
“All training should make you actually do something and then prove you have done it!”
It was also the case that some changes, celebrated as improvements to current practice by the panel, were not possible to implement because of organisational barriers.
Outcomes
All the original project objectives were met.
Impact of organisational and workforce change However, although at project completion it could be said that both aims had also been met, in the intervening period between then and now it is clear that the initial impetus to inclusion given by the project has not been sustained.
This, I believe, is primarily accounted for by the amount of organisational and workforce change which has taken place during this time. Currently, the support needs of people with acquired communication disabilities are not routinely proactively met by the Health and Social care providers in Dorset.
Notwithstanding this, the impact of the training has resulted in some systemic changes to my own organisations thinking, which has led to a greater openness and willingness to adapt when the need is pointed out. In addition, within the Dorset Clinical Commissioning Group (CCG), which absorbed the Stroke Network in 2011/2, CCG initiated engagement with the public and patients continues to be mindful of the needs of people with acquired communication disability.
The ethos of the training package was taken up by the Dorset Cancer Network and incorporated into an end of life conversations training module which was produced and delivered to both health and social care staff. This included the production of a DVD which featured people with aphasia talking about how the breaking of bad news could be handled for someone with a communication disability.
RCSLT - CQ Live 2016 Inclusive Communication - case study
As a culture changing initiative I believe the project has had influence.
Professional doctorate More personally, I took my own experience of designing and running the project into a professional doctorate which I will, hopefully, complete this summer.
Further information Connect, the communication disability network, still offer the Communication Access Toolkit training. Project author: contact [email protected].
RCSLT - CQ Live 2016 Inclusive Communication - case study