How technology can improve residents' well-being
Four Seasons Health Care's Quality of Life programme collects and acts on feedback
Four Seasons Health Care staff explain how its Quality of Life programme uses technology to collect meaningful feedback
- Care homes operator Four Seasons Health Care has developed a programme to improve everyday lives of care home residents
- The Quality of Life programme engages with residents, their families and healthcare professionals through use of technology
- Continuous feedback ensures that every aspect of the home is tailored to what residents want
Care homes must record and understand residents’ real-life care experiences so problems are addressed quickly and residents can do more of what they enjoy.
In the past it has been difficult to engage residents in meaningful collaborative service development. Annual paper surveys have a low completion rate and residents and their families can be reluctant to provide feedback that could be perceived as negative.
The volume and quality of feedback Four Seasons Health Care is able to access through its Quality of Life programme is substantially increased.
Quality of Life programme
The programme includes:
- Wi-Fi enabled tablets in the homes allowing live feedback and comments about services. Feedback can be provided anonymously
- Purpose-designed software
- An extensive IT upgrade programme
- Immediately accessible information in electronic formats with the ability for regional managers to review and monitor individual resident care audits
For more details on the Four Seasons Health Care Quality of Life Programme click here
Feedback questions have been developed with residents, families, professionals and the teams in the homes to focus on what they think is important:
- Is the home a happy place to live?
- Does the home provide good quality care?
- Do you feel safe and secure living here?
- Are the team members friendly and helpful?
- Do you feel your views are listened to and acted on?
- Would you recommend the home to friends and family?
There are four additional themes that rotate on a quarterly basis looking at the environment, dining, activities/social life and housekeeping.
Easy to understand and relevant
The questions were amended at the end of 2018 to make them easier to understand and more relevant to residents.
Wi-Fi enabled tablets are used to answer these questions and to send general feedback such as comments on the food, suggestions for specific activities and comments on members of the team or aspects of the home.
In 2018 Four Seasons received 113,000 pieces of feedback from residents, relatives and friends, and professionals. Residents provided 91,000 pieces of feedback, an average of seven feedback forms per resident over the year. The overall satisfaction score was 98%.
The results from the feedback have affected the day-to-day lives of residents at home level and across the organisation. Nurses and care teams in the homes can react to comments immediately to remedy short-term issues, or see patterns emerging, allowing them to devise longer-term solutions.
Head of nursing Joanne Strain says: ‘The programme provides nursing, care and support teams with unprecedented levels of feedback and information to ensure a better connection with residents and their families. This helps to drive more personalised levels of care at an individual level, in a particular care home and at a regional level. The IT systems and software allow nurses to provide their opinions and raise any concerns.’
Ten tips for a successful resident feedback programme
- Involve residents, relatives and care teams in the development of the programme
- Be clear on the benefits to residents
- Keep the questions simple and relevant
- Use visual aids such as images and emojis to engage
- Be flexible with the way the technology is used – the iPads are there to enhance residents’ lives however they see fit
- Link the actions from the feedback to the relevant people
- Monitor how well and how quickly actions are dealt with
- Invest in the technology up front then develop and refine the systems to suit your needs
- Demonstrate the outcomes to all relevant audiences
- Make it easy to use for everyone
Watch: Transforming Care with Technology
How feedback has helped improve residents’ lives
Question: Is the home a happy place to live?
A home in Essex received feedback from a relative that another resident had been rude to her mother on several occasions. The home manager was able to speak to the resident directly and offer to move the resident’s chair to a different part of the lounge. When the resident’s husband came in later to raise the issue, the manager was able to say that he already knew about it and that it had been resolved. The manager thought that without the feedback facility available in reception it would probably have led to a formal complaint resulting in manager and nurse time spent investigating, documenting and communicating the response.
‘The feedback mechanism allowed the resident to comment without “making a fuss”’
A Staffordshire home received feedback about a resident’s day-to-day happiness: ‘When I’m sat in the lounge sometimes they draw the curtain, but then I can’t see the birdhouse. And I enjoy watching the birds in an afternoon.’ A simple solution was to ask the maintenance staff to move the birdhouse to the next window. The feedback mechanism allowed the resident to comment without ‘making a fuss’ or potentially upsetting the other resident who felt the cold. The feedback arrived immediately and the birdhouse was moved on the same day.
Question: Does the home provide good quality care?
One home found a recurring lack of availability of medication for a resident. Instead of resolving this individual instance by obtaining additional medication for the resident, the home looked at the root cause and identified that a change in the delivery time was required. The feedback allowed the home to see the pattern and tackle it quickly with the supplier.
pieces of feedback were received by Four Seasons Health Care in 2018 – 98% of which was positive
A regional manager reviewed the feedback given in homes in a region and identified concerns about food and nutrition. The manager was better able to direct the peripatetic chef to develop an appropriate solution.
Question: Do you feel your views are listened to and acted on?
At a care home in Derbyshire, feedback from a relative stated that a new resident was worried about moving into the home, and that little things might go unnoticed by the care team. For example, she liked her clock in a particular place and a book at the side of her bed for when she was unable to sleep. The home then knew to talk with the resident about any fears she might have, provide reassurance and introduce a carer as her key worker.
This small but valuable piece of feedback made the team aware that this person had concerns about moving to the care home. It also reminded colleagues that many people are unfamiliar with the care home environment and of the role that nurses and care teams can play in putting them at ease.
Question: Would you recommend the home to friends and family?
In North Lincolnshire a home manager received comments from residents saying that they were unhappy with the activities. She spoke to a group of residents about what was working and what could be improved.
The feedback showed the residents enjoyed the activities on offer and thought the activities coordinator was doing a good job, but they wanted more to happen at weekends when they often had fewer visitors.
In response the activities coordinator changed her working pattern and now comes in on Saturdays and Sundays, facilitating trips to the shops, chapel visits and the popular Sunday movie night. The home manager said: ‘The feedback worked for the residents and it worked for us as a home.’
After feedback about dining at a home in Stoke-on-Trent, significant changes were made to the overall dining experience, mealtimes and menus. The menu was amended to provide more ‘homely’ traditional meals and to introduce some local favourites such as oatcakes and lobby (a meat and vegetable stew). Mealtimes were moved so that the larger meal was in the afternoon instead of lunchtime, as many of the residents were still full from breakfast and did not want a large meal.
This type of change often has an immediate positive effect on residents’ health and well-being, with a knock-on reduction in nurse time spent on nutrition and hydration issues.
Dining is a central concern for residents living in care homes, yet many say they ‘don’t want to be seen as complaining’. The specific questions give residents the freedom to comment without feeling like they are complaining, meaning homes can find and fix issues before they become formal complaints.
At a home in Halifax resident feedback was received of clothes coming back from the laundry creased and in need of ironing. The home manager held a meeting with the laundry staff to find out what was happening. It transpired that clothes were being ironed but to distribute the clean laundry to each resident, they were being stored in small boxes which creased them. The home introduced a hanging rail. The residents were able to resolve an annoying issue and receive clothes laundered to their high standards.
After visiting her mother at a home in Essex, a resident’s daughter left a comment on the tablet that she thought her mother’s sheets were unclean. The home manager checked and found something had been spilled on the sheets. She immediately had them changed and by the time the daughter arrived home there was an email telling her that her mother had fresh sheets on her bed. The speed that the feedback reaches the relevant person is reassuring to residents and family members.
An important factor of the programme has been the accessibility and convenience of the system for all potential users. This type of programme is changing perceptions that care homes are behind with technological developments.
The programme enables feedback to be captured from residents with varied levels of communication abilities. For residents who are living with cognitive impairment resulting from dementia, colleagues are able to capture feedback through the company’s bespoke thematic resident and care audit for dementia, which forms part of the suite of technology that has grown from the programme.
‘This type of programme is changing perceptions that care homes are behind with technological developments’
There is an option for each question to select ‘unable to answer’. If the person is unable to answer the majority of questions the surveyor can return to the observational element of the survey and fill it in on their behalf. For example, if a resident is unable to provide feedback on the question ‘do you enjoy the food provided?’, observation of that resident eating or not eating a meal ensures their experience is included.
Emojis were introduced to the satisfaction surveys to make it easier for people with cognitive impairments to complete them. A relative or carer can read the question, but the resident is encouraged to choose and touch the appropriate response themselves.
For residents who cannot engage proxy feedback is important. Positioning tablets in reception and dining areas and encouraging relatives and visiting professionals to engage gives them an opportunity to provide feedback on their behalf.
Engagement of residents and teams in the homes was a significant challenge. The care home operator wanted the programme to be seen by teams as an enhancement to everyday lives, rather than an additional job.
To introduce the technology, the teams were encouraged to use the tablets for everyday activities such as watching videos or listening to music.
At a home in Stoke a resident began using the tablet to watch YouTube videos, referring to it as the ‘little TV’. This provided the carer with a way of interacting with the resident that was focused around his interests and naturally led to asking him different questions about life in the home and requesting feedback through the tablet.
Beyond the original scope of the programme, residents have been taking advantage of the opportunities that internet access and tablets provide.
They have adapted to using the technology to keep in touch with relatives or friends who live far away, for shopping online or to follow personal interests.
One resident in Wales was unable to attend her grandson’s wedding, but with the help of the team in the home and the tablet, she joined the wedding via Skype. She put on her wedding outfit and managed to join the ceremony from her bed.
Using the tablets for everyday fun and social interactions has encouraged their use for feedback.
Clinicians working in care homes have a duty to deliver good care and high-quality clinical standards. For residents a positive experience of living in a care home should be more than receiving good clinical care. The things that are outside nurses’ clinical remit can have the greatest effect on residents’ happiness and sense of well-being.
The Quality of Life programme provides residents with an opportunity to tell the care home operator how they feel about the big things, but more often than not it is the little things that make a difference to their everyday lives.
‘I knew nothing whatever about these new-fangled gadgets but once I saw the tablet I thought “Oh, I could manage to use that all right”’
‘I thought it would be harder than this but it’s really simple’
‘If you have a tablet you’re never alone. You’ve always got someone or something there’
‘You’ve always got a way of expressing how you feel through the tablet’
Nurses’ and home managers’ comments
‘Some of the older people find it a bit difficult to complain. So it is a lot better and a lot easier for them. And it’s a lot better for us that things aren’t getting built up in a relative’s point of view’
‘Quality of Life has been effective in helping us improve our dining experience, mealtimes and menus’
‘When I’m out of the home the tablet system now allows me to remotely access when questionnaires have been completed. If it’s good feedback that’s fine, it reinforces that things are working well. If there is any action required I’m able to pick up the phone and speak to whoever is in charge that day and ask them to address that before I’m even back in the home’
‘It’s been good to see the residents become involved. We continually improve from the residents’ feedback, it’s not just from professional visitors or colleagues. We like to take what our residents say about the home as well. We use their feedback as constructively as possible’
‘Some of the residents don’t like to, as they put it, “complain”. Which is not really a complaint, it’s just something that they want. Also without the programme feedback we probably would never have known this’
Find out more
About the authors
Claire Royston, group medical director; Colin Sheeran, lead project facilitator; Hannah Miller, project facilitator; Laura Steward, project facilitator; Cate Lawson, customer insight and UX manager; Joanne Strain, head of nursing – all at Four Seasons Health Care