Table 4. Lessons learnt and implemented as a result of the feasibility study.

External facilitation from the CSNAT team

a) Initial training

Following the initial feasibility study the CSNAT was rolled out to six hospices as part of a further study. The original training sessions were extended and revised in order that more information could be provided on the evidence-base of the tool and how it could be used to enhance existing practice. Emphasis was placed on the difference between existing informal, practitioner-led, approaches to carer assessment and the CSNAT, which provides structure for a carer-led, practitioner-facilitated approach. The primary message conveyed was that whilst the CSNAT provides a framework for the assessment process, it is not simply a form. Vignettes were also shared, which give ‘real life’ examples of how of how the CSNAT has achieved successes that would not have been possible with ‘existing practice’.

b) On-going facilitation

Following the initial training sessions a further follow up visit was made to each participating site around six weeks post implementation. This meeting with practitioners provided the opportunity for them to discuss how things were progressing in relation to the implementation of the CSNAT, this allowed for any queries or misconceptions to be discussed at an early stage. Provision was made for a CSNAT ‘champion’ who acted as an internal facilitator for the CSNAT within their service and acted as a link between the organisation and the CSNAT team. Support for the champions was facilitated by the CSNAT team via a series of one-to-one phone calls with the individual champions and provision of occasional ‘Skype’ and face to face meetings with fellow champions. Internal facilitation from the organisation

a) Organisational preparation

The lessons learnt from the study were incorporated into an advisory document which identified the organisational preparations required prior to implementation of the CSNAT, in particular the internal facilitation processes that needed to be in place. Attention was drawn to the need for a ‘change management’ approach to be considered to support implementation.

b) Core group

Sites were advised to have a ‘core group’ of individuals who could help steer the implementation. This core group comprised the champion, service manager and an administrator. Sites were also encouraged to frame the implementation as a service development by which new evidence on carer assessment could enhance practice and build on existing skills. Sharing of experiences of using the CSNAT was encouraged in order that practitioners could support each other and ‘early adopters’ of this new approach could illustrate how this tool enhances existing practice and any potential hurdles to implementation could be overcome.