Table 1.

Description of the PEACH Quality Improvement Collaborative.

Brief Name	The PEACH Collaborative
Why	The aim was to improve healthcare for care home residents, and CGA was used to guide discussions.
Where	Nottinghamshire, UK. Collaborative shared learning events were carried out at a university location, and in between events (action periods), teams met in local care homes and at local Clinical Commissioning Group (organisations which plan and purchase healthcare services) locations.
Who provided	The PEACH collaborative was delivered by a team comprising a locally known clinical academic geriatrician, a nurse leader with expertise in appreciative inquiry to promote quality of life in care homes, a Health Foundation QI Fellow, and a researcher with interest in improvement science. The overall PEACH programme was funded by The Dunhill Medical Trust (grant number FOP1/0115). The collaborative shared learning events were funded by the East Midlands AHSN Patient Safety Collaborative (https://www.emahsn.org.uk/our-work/patient-safety).
Recipients	The collaborative took place across a region which has four distinct sites, and a team formed in each site. In each site, the person responsible for planning and purchasing healthcare services (commonly referred to as “commissioners” in the UK) for older people recruited a team. Teams were multidisciplinary and included general practitioners (GP), nurses, therapists, geriatricians, pharmacists, dementia specialists, care coordinators, care home workers/managers, and voluntary sector staff. Members of the public with experience of care homes were also recruited to teams. The configuration of teams varied and depended on local resource and staff availability.
How	Face-to-face meetings.
When and how much	18 months (September 2016 to February 2018), with four collaborative shared learning events that took place approximately every 6 months.
What (materials and procedures)	Collaborative shared learning events: The events included: Allocated time for teams to discuss and reflect on their local needs and priorities. Allocated time for teams to brainstorm and develop QI plans. Sessions for each team to present and share their project ideas, progress, and experiences of the improvement journey, describing challenges, successes, and lessons learnt around how to overcome barriers. Educational/learning sessions (described below). Networking opportunities. Educational/learning sessions: the events included educational elements, with training delivered on: QI techniques: setting SMART (Specific, Measurable, Achievable, Realistic, Timebound) objectives and testing change ideas using a PDSA approach. An educational game using “Mr Potato Head” was carried out to demonstrate the PDSA approach, teaching teams how to set goals, and test change ideas CGA and using this approach to care for older people. Action period group meetings: during action periods (the time in between each shared learning event), teams met at their own site locations to review and progress their improvement projects. Coaching: a Health Foundation-trained QI fellow on the team (JB) provided coaching and mentoring to individual teams, both at shared learning events and also during the action periods. Signposting teams to relevant contacts and resources: when collaborative teams faced challenges, the improvement team helped by signposting to relevant contacts and resources. Newsletter: provided project updates (i.e., meeting dates) and team stories describing progress with QI projects. Shared through email, with approximately three newsletters per year. Administrative support: the project improvement team provided the collaborative teams with administration support during action periods, for example, arranging meetings and circulating meeting agendas/minutes. Support with data collection: the collaborative intervention was one component of a programme of work which included work packages orientated around evaluating the activity of the QIC, collecting data around health care service use, and care home resident wellbeing. Collaborative teams were offered support with data collection and evaluation.
Tailoring	Shared learning events included features designed to create a safe working environment and reduce effects of perceived hierarchy amongst teams: Ice breaker activities to enhance relationship building. Time was spent at the beginning asking teams to consider items to add to a list of “ground rules”, for example, (i) no question is a silly question, (ii) everyone listen when someone is speaking, (iii) mobile phones on silent. Team members were asked to comply with these rules throughout the events. All activities maintained an appreciative enquiry approach, using positive and encouraging language, e.g., asking teams to focus on what is working well and why, envisaging how things could be, and identifying how to work together to make it happen. GPs and care home staff were provided with backfill payment for their time taken to attend events as they are independent sector workers and only able to attend meetings if adequate staff cover is arranged to cover workload.
Modifications to the programme	The original plans included carrying out conference calls as another way to meet and discuss progress with improvement work. The conference calls would take place during action periods and involve each collaborative team with the improvement team. One conference call was carried out and not repeated as face-to-face meetings were more effective for reviewing and discussing project progress.
How well	Over the course of the project 34 (out of 44) NHS and care home staff attended at least 2 (out of 4) collaborative meetings.
Project evaluation	Process evaluation to understand how the QIC approach works, for whom, and in what ways when used to implement and deliver CGA in care homes. This evaluation uses a realist methodology; a detailed research protocol is available elsewhere [17]. QI project evaluation to examine the impact on resident and service outcomes. A combination of interrupted times series, stepped wedge cluster design, and quasi experimental approaches were used, and are described in more detail by Usman et al. [18].