bluuebunny/crossref_metadata_2025_split huggingface dataset:
P61 How do Hospices perceive their role in the current Health Care Environment? A View from the Top
Authors: Linehan Gaberielle 
Published: October 2013

A qualitative study using a critical review of the literature and semi structured interviews with a small sample of Hospice Chief Executives explored their perceptions of the impact and effect of the national policy agenda on their organisation and hospice care in England.The findings from the research indicate that hospice services continue to be influenced by their history and legacy. The ‘arrogance’ of hospice organisations viewing themselves as ‘set apart’ and in charge of their own destiny is set to be challenged by the new world of commissioning. Operating outside the National Health Service but dependent on partial funding to provide end of life care services to patients, they are trying to be innovative, challenge existing cultural norms, engage a wider populace and redefine the parameters of what they can offer while maintaining ‘independence’.The national drive to support care in the community is refocusing hospice care into the community with outreach support and engagement with other provider services, rather than inpatient provision. This integrated approach poses conceptual difficulty for hospice staff.The balancing of the historic context with external demands of an ever changing health care landscape focused the CEOs interviewed to discuss the change in identity of hospice from a ‘building’, to a community outreach service with access to specialist resources- a significant turning point. Increased visibility impacted on how hospice was viewed by the wider healthcare economy, rather than, ‘do gooding’ little charities, but as part of whole service provision. The struggle between independence and integration is a tension for hospice particularly related to outcomes and demonstrating the unique role of palliative and EoLC.The study also highlighted how policy has influenced hospice to reframe as small business units taking a commercial view of their service configuration which all CEOs viewed as a challenge.
P62 Managing change in challenging times
Authors: Parkes Nicola 
Published: October 2013

IntroductionAs hospices face challenges, there is a need to balance the economic cost and the demands placed upon the services we provide, leading to new ways of working and changes within the organisation.Change can be difficult and can often be seen as being “done to” as opposed to being “part of “the process.AimsThe aim was to find a simple tool to use within teams to engage them in the change process and to illicit issues that where pertinent to them in the future development of the service, and to identify areas in which efficiencies could be made.MethodWe devised a simple tool which enabled staff to state what they wanted to “Stop, Start and Keep” within the services they provided.DiscussionThis tool was used in an “away day” style environment, the whole team where engaged in the process and the use of the tool elicited themes from the team in relation to the questions asked, and enabled the team to develop a plan for future developments and discuss key areas of concern.There was an over arching theme related to maintaining quality which underpinned all such developments and a desire to ensure the quality of care patients received was not adversely affected. The use of the tool acted as a bench mark to where we are now and where we wanted to be, and enables the team to review progress, its impact and celebrate success.ConclusionThe use of this tool enabled the team to feel engaged and contribute to the development of new ideas and ways of working in challenging times. The process is fluid and enables teams the opportunity to revisit and review and address issues and developments.
P63 Fit for the future…. Empowering an organisation through strategy delivery
Authors: Neely Roslyn 
Published: October 2013

BackgroundThe organisation has created a visionary strategy to position them as an influential, leading paediatric palliative care provider in Scotland, the UK and beyond. In creating this, there was an opportunity to truly engage with all those involved in the organisation; reflecting visions and hopes for the future through collaboration and consultation. Children, young people and families using the services; trustees, staff and volunteers were consulted through a series of focus groups, externally facilitated to maximise objectivity. This was the starting point for a dynamic ongoing strategic planning process to ensure the organisation is in a strong position to meet the changing needs of babies, children, young people and their families in a changing political and financial landscape.MethodA number of sessions were held to explore what the future might hold for the organisation over the next ten years. This has included exploring the changing needs of the children, young people and families who will use the service; considering new ways of delivering care, skill mix review, the hospice environment, income and expenditure projections, the political landscape, policy and partnership working with statutory and voluntary organisations.OutcomesTwo years on and the resulting strategic plan is delivering measurable outcomes which are positively impacting on the care and support being given to families. The organisation has also influenced the development of a Framework for the Delivery of Palliative Care for Children and Young People (2013). Staff, volunteers and service-users are motivated, guided and empowered by the plan. The plan has raised awareness of the organisation within health and local authority networks, resulting in increased referrals and funding.
P64 Financial planning for uncertainty
Authors: Ryan Alison , Keep Sheena 
Published: October 2013

IntroductionIn common with other independent hospices, Weldmar Hospicecare Trust faces considerable uncertainty over the size and nature of future income. This paper describes the financial modelling which allows us to make sound financial plans despite that uncertainty.AimsTo create an understanding of our complex finances so we can focus on the most impactful income generation, control expenditure and use our Balance Sheet strength to create a future where we are no longer dependent on any one source of income.Approach usedanalysis of expenditure and income steams by type and cost centre (80 + budget lines).Application of differential growth/cost pressure assumptions to each line on an Excel model which allows assumptions to be changed producing different results.Outcomesthis command of our finances has allowed us to:make budget adjustments in the context of securing long term strength,to manage sudden unforeseen changes (such as 90% failure of legacy income in one year) without making damaging short term cuts,to distribute resources to staff via pay in a way which is sustainable and transparent and affordable,to invest in income raising possibilities even while running planned £1million deficits.Our model shows that in four years’ time we will have generated sufficient surplus to minimise the impact of loss or reduction of NHS income should competitive tendering produce such a result. It provides a clear guide to managers on how service development can, or cannot, be afforded.Application to hospice practiceHospices have complex and unpredictable income streams – NHS, trading, legacies, donations, investment and relatively fixed costs – largely staffing. Without a long term view, short term reactions to financial hiatus can lead to unnecessary curtailment of services, loss of opportunity and lowered morale. This model minimises those problems.
P65 Developing a culture of good leadership and management
Authors: Kelly Lynn , Greenhalgh Stephen 
Published: October 2013

BackgroundLittle interaction between managers across different directoratesNo sense of ‘team’ amongst managersLack of consistent approach and varying degrees of management experienceAimSet standard for leadership & management amongst middle managersRaise confidence of managers in dealing with staff performanceDevelop team working across departmentsEnable managers to contribute to and deliver the Hospice 5 year planApproach UsedResearched suitable providers, developed partnership with Lancashire Teaching Hospitals NHS Foundation Trust Leadership and Organisational Development TeamTraining Needs Analysis - rated confidence across different leadership and management areas and then prioritised for development.Key components:7.5 days of group trainingLeadership & Management Situational Judgement TestSelf-assessment against NHS Leadership Framework1–2-1 with advisorGroup project work / presentationImpact evaluation (due June 2013)ILM Level 5 qualificationOutcomes‘The difference in the first Management Team meeting following the course was tangible and exciting. Colleagues were more confident, open and prepared to actively challenge and contribute. I came away greatly encouraged by the credible difference which entirely justifies the investment that we made into establishing an Education Team that can sharpen our business effectiveness at every level just at a time when we need it most!’–Stephen Greenhalgh, CEOIn my directorate, confidence in their own ability springs to mind, they have been committed to the appraisal scheme and cascading from the business plan to performance plans”–Lorraine Charlesworth, Director of Income Generation“My attendance on the Management course assisted me to reflect on my Management style and enabled me to increase delegation to my staff. It also improved my working relationship with my line Manager and other Managers on the programme.” -Cheryl Scott, FamilySupportTeam Manager“One of the most practically useful courses I’ve ever been on - combined theoretical and applied knowledge made the content easily transferable to the workplace. I have already implemented many changes within my team."Katie Russell-Paddison, HeadofAdminKey Operating PrinciplesDeveloping leadership for a new eraDeveloping the hospice workforce
P66 Developing and supporting management and leadership within a hospice
Authors: Kennedy Joanna , McClinton Pam , Thomas Joette , Wallace Duncan 
Published: October 2013

This abstract outlines the innovative way the North London Hospice sought to improve the effectiveness of all of its leadership and management practice using values as a bedrock.From 2011 – 2013, the Animate team developed and ran a management development programme for all 31 managers from across. The purpose of the programme was to provide an integrated learning opportunity that strengthened the skills, understanding and effectiveness of the management of the HospiceThe design of the programme paid attention to the environment in which the staff worked. A wide variety of issues were raised for them which had implications for creating a system of management and leadership which truly integrates core values throughout the organisation and into all aspects of care.The programme enabled participants to analyse their own experience using a collection of theories and frameworks, which deepened their understanding of their role. It addressed the particular management challenges of working in hospice setting where staff are mostly highly motivated, passionate, inclined to work very hard and exposed to a high degree of emotion in the course of their day. It included both opportunities to reflect through action learning and focused action planning.Six months after the end of the programme the Executive Team were seeing the impact on management practice. They were noticing managers broadening and adapting their leadership styles to suit different situations. They also observed tools and frameworks being successfully used to analyse difficult problems and plan new initiatives. They were seeing managers being more confident and clearer about what their role involved. The greatest impact was on opening up and deepening learning across departments, disciplines and teams.Animate has now teamed up with the North London Hospice to design and deliver programmes in other hospices tailoring the content to meet particular contexts.
P67 Using a service evaluation to drive change and improve quality
Authors: Newman Peter , White Jane , Plowman Martin 
Published: October 2013

IntroductionDreams Come True is a national charity providing dreams for children age 2–21 with life-threatening and life-limiting conditions. As part of our overall commitment in our 25th year to improving the quality of our dream delivery service, we have embarked on a programme of service improvement. Voluntary organisations have a key role to play in palliative care pathways and it is important that the sector is a serious partner in the drive to improve services.AimThe starting point was an independent service evaluation designed to evaluate the views of all our stakeholders: the internal team; the key professionals who refer to our service; and most importantly the families that we serve.MethodsThe study methodology used a combination of nominal group technique for parents and staff team and email survey among key referring informants.ResultsThis paper will focus on the lessons learned by the charity in undertaking the study and will describe the process of internal review, re-evaluation and implementation of change that has now been actioned. Such changes include ways in which we will be involving families and communications practices with professionals as well as a re-evaluation of our services to young adults in transition.ConclusionWe will describe the ongoing methods by which we will monitor the impact of those changes which we hope will achieve quality improvements to all stakeholders in our organisation. It will be of interest to other voluntary organisations supporting palliative care services nationwide especially those considering undertaking a service evaluation. It will also be of interest to children’s hospitals and hospices with an interest in the professionalism and effectiveness of the service delivery of such voluntary organisations.
09 Use of video consultation at the end of Life - supporting care at home
Authors: Malin Rebecca , Wilson Linda , Pope Richard 
Published: October 2013

IntroductionPeople at the end of life (and their carers) require support on a 24/7 basis. Access to appropriate, immediate advice is important to optimse the quality of care, reduce anxieties and where appropriate avoid hospital admission. Use of video links to the home may allow such services to be delivered in a scalable and affordable way.AimsTo develop reliable means of deploying high quality video links between hospices and a person’s own home or residential care setting.MethodsUsing standards based, resilient videoconferencing, running over domestic broadband, links were established between a hospice and patients receiving support at home and in a range of residential care settings. The service also linked patients to the local acute hospital’s teleconsultation centre. Staff at the hospice and patients/carers were able to both make and receive calls at any time. Proof of concept outcome measures included the ability to create a stable video link in a domestic setting and identification of clinical use cases where video enabled safe, appropriate care delivery. Qualitative indications of patient, carer and staff satisfaction with the approach were also recorded.ResultsWhere broadband speed exceeded 500kb/s (up and download) we established reliable video connexions in all cases. Service users were able to receive general symptom control and treatment advice, it was possible to avoid need for admission or to expedite admission when necessary. Staff and patient satisfaction with the approach was high, averaging 8.5/10 across a range of measures. The service is expanding to include links to all local Nursing Homes and to allow on-call palliative care consultants to join calls from their own home.ConclusionUse of video-consultation to the home enables immediate delivery of palliative care support without need for travel and may avoid the need for some hospital admissions. The approach is valued by users.
P68 Lean - Looking with fresh eyes
Authors: Bridger Susan , Collins Debbie , Loan Rebecca , Tomsett Jacqui 
Published: October 2013

IntroductionThe hospice has continually strived to provide the most efficient and streamlined services possible, right across the organisation. In August 2011 in was decided to introduce ‘Lean’.organisational improvement principles. 4 staff from different departments were trained as Lean Advisers to embed the principles of Lean within all areas of the hospice.This is the journey of the introduction and development of ‘Lean’ to support organisational improvement.AimTo demonstrate the development of the role of the ‘LEAN’ Advisers to empower and support staff in their review of departmental processes using ‘LEAN’ principles and techniques.To discuss process and outcomes of projects undertaken in clinical care, fundraising, staff support and environmental efficiencyTo discuss lessons learntTo discuss where we go from hereMethodsDeveloped a timeline to plot the journey to introduce Lean Principles.Ongoing training provided on a voluntary basis by a Lean consultantUse of a variety of Lean tools to collect and analyse dataResultsTo date two projects have been completed - 1 reviewing and streamlining of the patients journey through the hospice which has resulted in cost savings on staffing and an increase in patient contacts by community staff. 2 the running and management of OT & Physio equipment stores which has resulted in a more efficient and safer service to patients. 3 other projects are in progress.ConclusionIt is far too easy to offer solutions to a problem before understanding what is really going onIt is far too easy to implement a process/solution for a problem and then think the job is doneA group of people from different backgrounds with LEAN training can make a massive difference to a service
P69 Recruiting our workforce using value based interviewing
Authors: Power Rachel 
Published: October 2013

National research and enquires have highlighted a gap between the espouced values within care environments and the quality of care people receive. Richard House recognises the relationship between high quality care and the values and attitudes of staff and volunteers.Richard House implemented value based interviewing (VBI) as part of our recruitment process in 2012 to seek to ensure that the values of Richard House are reflected in the day to day care and support it provides to children, young people and their families.Core values were drawn up by the staff and volunteers who also helped develop the positive and negative indicators.Value Based Interviewing is underpinned by robust research and it has been proven this interviewing method facilitates the recruitment of people more aligned with organisational values and behaviours and helps recruit high performing and effective staff and volunteers.VBI has been used and established in a number of organisations including the NSPCC. It has been shown to effectively identify candidates who are a “better fit” for Richard House and therefore the right people to support the service for children young people and their families.
P70 Developing and celebrating good practice in a hospice setting: equipping a workforce for a changing and uncertain future
Authors: Griffith Sue , Powis Kate 
Published: October 2013

BackgroundIn the current climate of austerity and need to demonstrate that hospices are able to prepare for a changing future of widening access, it is important that hospices take every opportunity to develop practice and ensure the whole workforce is abreast of current thinking. Furthermore, this development must be made explicit to staff and all stakeholders. Having always prided itself on being a centre of excellence, this hospice sought to demonstrate this by being recognised as a practice development unit.ApproachAfter working with a university to reach first stage accreditation, it was acknowledged that the framework to achieve this was too rigid and costly for a charitable organisation. The existing education and research group was amalgamated with the practice development team to create a Hospice Education And Research and Development (HEARD) group to ensure that every aspect of hospice care follows a practice development approach.OutcomesThe group HEARD offers everyone in the organisation a voice, and a place for their development ideas to be heard. It meets bi-monthly to examine current practice, ideas for research and publication, and to plan a series of learning events to meet changing educational needs of all hospice staff. This plans to generate evidence, develop practice, disseminate good practice, and share best evidence through a journal club, with a focus on developing the workforce and leadership abilities through a largely bottom-up approach.ApplicationTo preserve the academic rigour of the practice development process, eight criteria were created to guide innovation, and the group has a steering committee. Two successful celebration days have now been held to showcase practice developments to stakeholders and staff. An electronic source of educational information has developed from this; the research behind which, as well as other developments, have been published and shared at international conferences.
P71 Intergrating a new hospice pay policy with a nursing competency framework
Authors: Bacon Ruth , Schrikker Tara , Clarke Karen 
Published: October 2013

IntroductionThe hospice decided to formulate a new nursing pay structure which moved away from Agenda for Change principles and integrated an updated competency framework.AimsCreate a pay policy to reflect local market conditions and respond to hospice needs whilst being flexibleDevelop a “balanced” nursing skill mix which reflects the hospice’s needsEstablish core requirements for each nursing postLink competence with payDevelop a pay and competence framework in consultation with staff.MethodUsing best practice documents, the hospice reviewed and updated existing competencies before implementation.Registered Nurses engaged with the new process by:-Attending teaching sessions onIntroduction to Competencies: How, What, Why and When!Getting Started with your CompetenciesMeeting with Line Managers on a 1:1 basisA structure consisting of Foundation, Intermediary and Tenure levels of competency and pay was introduced.ResultsThe implementation of a competence related pay structure appears to have had a positive effect on staff engagement and motivation. Improved awareness, communication, education and support have resulted.Staff feel more confident working at the competency level which reflects their experiences and skills.ConclusionHaving the competencies linked into Performance Development Review process enables a cycle of reflection, support, training and evaluation.The framework encourages and supports staff to work to their potential to provide specialist palliative care and respond to organisational needs.