Table 6.

Description of the South Sefton Care Home Innovation Program (CHIP) Quality Improvement Collaborative.

Brief Name	CHIP
Why	The aim was to reduce ambulance conveyances by 1/3 over 12 months from April 2015.
Where	Bootle, UK. The collaborative shared learning events were carried out at a neutral location (a hotel), and in between events (action periods), collaborative members continued to meet in their care home locations.
Who provided	The CHIP programme was led by two local general practitioners, and team members provided support with administration and with data collection and evaluation support. The project was funded by South Sefton Clinical Commissioning Group.
Recipient	31 care homes (both part residential and nursing homes) took part. The collaborative members comprised care home managers, senior and junior care staff, and over the course of the project, members from wider healthcare organisations provided input into improvement projects, such as community geriatricians, community matrons, pharmacists, palliative care specialists, voluntary organisations, tele-video equipment providers, and informatics.
How	Face to face meetings.
When and how much	36 months (April 2015–April 2018) with collaborative shared learning events every 2–3 months.
What (materials and procedures)	Forming the CHIP collaborative: prior to starting the CHIP collaborative, audits and interviews were carried out in individual care homes to understand and establish their needs. The CHIP collaborative was then designed to meet care home stakeholder requirements. Collaborative shared learning events: During events, each team was interviewed as a way of sharing progress, updates, and their experience of the improvement journey. Eduational and training (described below). Networking opportunities. Education and training: Training in QI methodology and QI techniques simplified through the use of games e.g., demonstrating PDSA cycles with Mr Potato Head. Training on how to use equipment being implemented in the care home, e.g., 24/7 tele-video in reach support. Training on basic observations and use of protocols with Edge Hill University. Awareness training from a variety of specialists. Care home teams were provided with support with data collection and interpretation: BI-level time series analysis was carried out and presented to care homes in an easy to digest way. Data were collected using data dashboards and monthly data trackers. Outcomes were focused on care outcomes and process measures at the care home level. Clinical support: Development of clinical protocols (e.g., standardised protocols topics such as falls and urinary tract infections). Relational coordination with care home matrons (care home matrons had easy and direct access to a community geriatrician, GPs, and other community specialist teams). Advanced care planning led by community matrons (the matrons collated background information, populated care plans, liaised with the GP or community geriatrician to complete and sign off care plans. Mostly done in liaison with GPs, and more complex cases referred to the community geriatrician). CHIP dashboard with “star” status: each home was given an individual attainment plan and “star chart” that helped them to reflect on areas of focus to enable scale up. CHIP champions: each care home selected a “CHIP” champion (e.g., care home manager or care staff). Champions functioned as a CHIP advocate and acted as the point of communication to both the improvement team and care home. Each champion was celebrated and recognised (e.g., given a badge). Care home support visits: the improvement team visited care homes regularly to carry out both reactive and proactive care. Any issues that they needed further support for were dealt with by contacting the GP or community geriatrician. Newsletters: monthly newsletter provided through email.
Tailoring	At the beginning, the improvement team spent time describing the purpose of the collaborative and their role, placing emphasis on the point that the improvement team were not inspecting or judging the care homes. Every collaborative shared learning event started with ice-breaker activities and a recap of the CHIP vision. Efforts were made to ensure meetings were facilitated in a way that created a safe, non-judgemental, positive, and celebratory atmosphere.
Modifications over the course of the programme	QI training materials were simplified as most of the collaborative members had no previous awareness of QI terminology or techniques (for example, simplified PDSA cycle templates were created). At collaborative learning events, instead of collaborative teams carrying out presentations, they were interviewed ‘on stage’ as a way of sharing progress to the collaborative. The time, day, and duration of collaborative shared learning events were changed to make it easier for collaborative teams to attend.
How well	On average, each collaborate shared learning event was attended by 63% of care homes.
Project evaluation	The impact of the CHIP collaborative on emergency calls and conveyances to hospital was evaluated using frequency analysis; more details are reported by Giebel et al. [24]. The CHIP project has been cited as an example of good practice by the CQC: see https://www.cqc.org.uk/sites/default/files/20160505%20CQC_EOLC_OVERVIEW_FINAL_3.pdf.