Table 2.

Description of the Safer Care Homes Quality Improvement Collaborative.

Brief Name	Safer Care Homes
Why	The aim was to reduce medication errors, falls with harm, and pressure ulcers.
Where	Salford, UK. Collaborative shared learning events were held at a local centre for QI (http://www.haelo.org.uk/about-us/), and in between events (action periods), the collaborative met during peer exchange visits carried out at care home locations.
Who provided	The Safer Care Homes collaborative was delivered by a local organisation called Haelo: an innovation and improvement science centre based in Salford, and commissioned by Salford Clinical Commissioning Group. The Safer Care Homes collaborative was delivered by a team including an executive sponsor (Safer Salford board representative), a consultant geriatrician, a QI lead, a programme facilitator, and a data analyst (measurement support).
Recipients	Nine care homes (mix of residential and nursing) took part and collaborative members comprised care home managers and senior/junior care workers from each participating care home.
How	Face-to-face meetings.
When and how much	13 months (January 2017–January 2018), with four half-day collaborative shared learning events that took place quarterly, and monthly peer exchange visits.
What (materials and procedures)	In September 2016, a local expert panel met to set the aims of the Safer Care Homes collaborative. The panel included commissioners, general practitioners, community geriatricians, safeguarding leads, pharmacy leads, and care home representatives. A driver diagram was developed which set out the aims and objectives of the collaborative. Collaborative shared learning events included: Sessions for each care home 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. The improvement team presented analysed data from care homes to the whole collaborative. Allocated time for each care home to examine and reflect on data, and develop action plans. The improvement team encouraged care homes to generate and test ideas that were aimed at reducing falls, pressure ulcers, and medication errors. Educational sessions (described below). Networking opportunities. Educational sessions: each event included educational elements, with training delivered on QI methodology. Influence of the care home on harm reduction. Coaching, data collection, and project evaluation: members of the improvement team visited care homes weekly to provide additional support with QI training and provided each home with data dashboards constructed from data submitted from the home. Peer support and exchange visits: collaborative members visited other care homes part of the collaborative as another way to share and exchange knowledge and experiences. This helped to develop a support network between the care homes. Awards and celebrating good work: at the summit event, care home members were recognised for their achievements with awards. All received an award for completing the programme, with additional awards agreed by the improvement team for “most improved”, “most innovative PDSA”, and “best use of improvement methodology”.
Tailoring	After the programme was completed, the improvement team adapted the model for improvement for a care home audience. This is called the “six steps to improvement” and is based on the learning and feedback from participants. This is available online at: https://safersalford.org/wp-content/uploads/2018/07/6-steps-to-improvement-30.04.18.pdf.
Modifications to the programme	Establishing a baseline number of falls with harm and medication errors was difficult, and for this reason, the improvement team worked closely with care homes to provide support with data collection and analysis. Initially, the improvement team planned that care homes would come up with their own innovative change ideas to test; however, the care homes preferred the improvement team to provide ideas based on evidence. One example of a change idea used to improve rate of falls is “pimp my zimmer”, an intervention where resident walking aids are personalised and decorated to help residents recognise and use their own walking aid, and also allow staff to recognise when a resident is using the incorrect walking aid (https://safersalford.org/case-study-pimp-my-zimmer/). Part-way through the collaborative period, it was recognised that care homes valued time to share and learn from one another and so “peer exchange visits” (exchange visits hosted in participating care homes) were introduced to enhance shared learning, exchange ideas, and develop support networks. Education and training on the influence of care home on harm reduction was introduced to help care homes see they can influence the reduction in harm, e.g., changing the belief that falls were either inevitable or caused by factors external to the homes. Although the focus of the collaborative was to reduce falls, pressure ulcers, and medication errors, the majority of the homes focused on reducing falls during the collaborative. Focus on medication errors was introduced later during the collaborative. This occurred after one care home joined the collaborative part way through and showed an interest in this outcome. Following this, other care homes also started to show an interest in this outcome.
How well	Collaborative shared learning event attendance was not assessed.
Project evaluation	Success of individual change ideas was evaluated using data dashboards. Each care home was able to see the impact of each intervention, which informed ongoing tests of change. Improvement in QI knowledge was evaluated through a comparative improvement knowledge survey, performed at the start of the breakthrough series, after each shared learning event, and at the summit event. Qualitative data were collected to reflect the impact of shared learning and collaboration between each care home (https://safersalford.org/safer-care-homes-summit-2/).