Dorset Adult Integrated Care Service (DAIRS): Service Evalaution
This source preferred by Edwin van Teijlingen
Publisher: Bournemouth University
Place of Publication: Bournemouth University
EXECUTIVE SUMMARY This early process evaluation of the newly established Dorset Adult Integrated Respiratory Service (DAIRS) in three localities in Dorset was conducted by Bournemouth University using a mixed-methods approach. Our evaluation showed staff commitment and enthusiasm for a pan-Dorset approach to respiratory care and a very positive acclaim from service users. Mindful of the fact that DAIRS had been in operation for four months only, the evaluation flags up strengths and issues of concern at the initial stages of service implementation. Discussion of the findings has been linked with current thinking to emerge in the White Paper from NHS Improving Quality around service improvement and change management (Bevan & Fairman, 2014).
Given that DAIRS has been commissioned in the first instance for a period of two years, this early evaluation will be valuable for stakeholders to address the issues raised in a timely manner. Recommendations 1. Build upon the high levels of satisfaction to engage service user users more widely in the on-going development of DAIRS.
2. Shared documentation needs to be agreed and implemented as soon as possible, including the DAIRS card.
3. DAIRS should be officially launched with appropriate information for different stakeholders: service users, community staff and non-DAIRS hospital staff.
4. The change process should be actively managed; concerns and challenges expressed by participants should be acknowledged and a supportive environment provided for collaborative problem-solving.
5. Consider selection and use of grass roots ‘change champions’ across the sites and disciplines to facilitate a more inclusive model of organisational change.
6. Further integration between localities should be explored particularly around staff education, as well as to facilitate on-going peer support.
7. New staff would benefit from being supernumerary for their first month and visiting neighbouring DAIRS localities.
8. Inclusion and exclusion criteria need to be revisited to ensure a shared understanding amongst DAIRS staff, particularly around co-morbidities.
9. Information and service provision concerning emotional support for service users and carers needs to be reviewed.
10. The current Single Point of Access System (SPOA) should be reviewed to improve compliance.
11. Information Technology (IT) systems and possibilities for joint DAIRS systems should be explored.
12. Perceived financial inequities need to be addressed in service planning. 13. Our evaluation provides a base-line for future work, a further more comprehensive evaluation after two years of DAIRS operation is needed to inform future funding and service development. Suggested factors to include: • Outcome data • Cross-locality service user involvement (avoiding winter peak time), using systematic PREM questionnaire distribution processes.
- Community staff perspectives.
- Input from related respiratory services, currently not part of DAIRS.
- Investigation of impact of a differing skill mix across localities. • More detailed service user feedback.
- Evaluation of staff education (DAIRS and non-DAIRS).