Report finds new programme could lead to shorter hospital stays

Health and social care staff who took part in a new programme that focused on hospital discharge think it could lead to shorter stays for patients.

Balancing rights and responsibilities (BRR): supporting a cultural shift integrated health and social care programme set out to put more of a focus on the strengths of a patient’s circumstances in discharge decisions.

We developed the programme by building on two existing health and social care programmes that shared common principles – Collaborative Communication Skills and Care Aims.

Through courses and workshops, we aimed to give those who took part more confidence to:

• listen to what patients think or feel
• reduce risk, rather than seek to eliminate it
• negotiate care decisions
• avoid the over-prescription of care.

Working with the NHS Delivery Unit, Aneurin Bevan Health Board and local authorities in Gwent, we tested the programme with professionals involved in hospital discharge in the region.

We carried out this work during the coronavirus pandemic.

At the end of the sample programme, Social Care Institute for Excellence (SCIE) evaluated how effective it was.

SCIE found that after the programme most participants felt more confident talking to patients about what matters to them. Almost everyone said they now had a better understanding of duty of care.

Of the 68 people who took part, 12 became ‘mentors’ or ‘champions’ and attended more training.

We also involved senior leadership by running a two-day course to introduce the programme’s vision and principles. We then invited them to join mentors at the end of the programme, to reflect on examples of good practice, achievements and barriers, and to work together on recommendations for the future.

Mentors with at least six months’ experience of BRR felt it could lead to a range of benefits, including:

• shorter hospital stays
• fewer return visits by repeat patients
• more joined-up care as multi-disciplinary teams take decisions together
• better recognition of the strengths of a patient’s situation, including family and community support
• earlier important conversations with patients and their families.

Everyone who responded to a follow-up survey said they would strongly recommend the programme to their co-workers.

To build on what we’ve learned, we’ll:

• share the findings across the health and social care sector
• work with Health Education and Improvement Wales (HEIW) to see how the findings can become part of the 10-year workforce strategy
• use our learning in work involving virtual wards, multi-professional frameworks and trusted assessors
• continue to deliver support based on outcomes and strengths and provide training across the social care sector
• work with Care Inspectorate Wales and partners on how to support positive cultures.