Starting small and learning fast

How often are you frustrated by the system you work in? You’re trying your best to help people – but somehow your efforts are not delivering the benefit – and you don’t know why?

At Kent Fire and Rescue service, Officers in the Safe and Well team visit people in their own homes. They fit smoke alarms and carbon monoxide monitors and provide other fire prevention items. They also give advice and – whilst they are there – spot other things that their customers may need help with. qic article starting small and learning fastThey are pretty good at identifying customers who are at risk of falls and can direct them to places where they can get help. However using some simple diagnostics we quickly identified a few barriers: Firstly customers were reluctant to take up the offer of a referral to the falls clinic and secondly, no one in the Safe and Well team knew if the people who they referred actually got the help they needed. Officers had some insight into the ‘reluctance’ to accept referral reporting comments like ‘I don’t think I could manage to get to a clinic as I’ve got no way of getting there anyway’ or ‘that’s the first step, but before I know it they’ll have me in a care home!’ To learn more about the referrals that were made we decided to use a method informed by improvement science called ‘small scale tests of change’ or Plan, Do, Study, Act (PDSA) cycles. This involves very small activities that are designed to generate learning to inform the next small activity. Through a series of small test cycles we were able to build up a picture that allowed us to improve the situation for customers who might be at risk of falls, and at the same time give the officers more confidence that their efforts around falls prevention were delivering good outcomes for their customers.

PDSA #1 (a-c) We don’t know what happens when we refer our customers to the falls service? Through 3 small test cycles we learnt that there was a mismatch between the criteria the Officers were using to refer and criteria the falls service used to accept clients.

“The consultants got a bit irritated with the increase in inappropriate referrals – so now I know why you asked us to keep the tests REALLY small”

“We only offer appointments to people by phone triage and we can offer home assessments. We don’t usually tell anyone if us or the client decline a referral.

PDSA #1 (d) What is the mismatch and what can we do about it? Building on the first three, we learnt from the fourth test cycle that the falls service only accepts people who have actually suffered a fall, so we need to change our process.

PDSA #1 (e) Can we refine our assessment to increase the number of people accepting a referral? Based on what we had already learnt, we changed our assessment form to make it easier for our officers to use it

“We now tell people what’s really available. More people have accepted the offer of a triage call – but we think we can do more for those who haven’t yet fallen badly enough to need the falls service.”

This was the Officers first experience of using this approach to change, and we have continued to use it to test a number of ideas designed to prevent falls amongst older people living in Medway.

This has been the first time that this approach has been used in KFRS. Officers have found it useful in the Safe and well work that they do – and in seeing the opportunity it might present in other parts of the service. ‘It has been a great pleasure to meet you and I have thoroughly enjoyed being part of the falls project’. ‘I hope to be able to transfer my knowledge to my new role and I will take the information regarding the project to my new manager’. The service has valued the way the learning has unfolded and you can learn more about this and how we have measured impact by click on this poster link Visit their website here: www.kent.fire-uk.org