General instructions for all assignments This is an individual assignment Prepare the assignment in.

General instructions for all assignments

This is an individual assignment

Prepare the assignment in a word processor document to upload on to the portal.

Your names and student number should be included in the title page of the assignment document, and all pages should be numbered.

Start each task (if there are many) on a new page in the document and provide a heading for each section. Paginate your document so that it is neatly presented.

The assignment must be submitted on or before the due date specified by the college. There are penalties for late submissions.

Collusion and copying are not allowed. Each assignment must be done entirely by you. There are severe penalties for copying and collusion including loss of marks in the assignment, failing the entire subject or dismissal from the course.

Outside materials may be used in assignments but all such material must be quoted and referenced if included verbatim. In general you should present your ideas and understanding in your own words.

All written or essay type questions in this assignment are to be answered in writing using a word processor. Use a proportionally spaced font such as Times Roman or Calibri 12 point for normal, essay-type written answers and 1.5 line-spacing.

THE SCENARIO

Holland Rise Health and Social Care Trust Background

Holland Rise Health & Social Care Trust provides community health care and social care services to a population of 100,000 people living in an inner city and suburban area of some 450 square miles in the United Kingdom. The Trust was formed five years ago from the merger of the up-to-then separate Holland Rise Community Health Care Trust and Social Services Departments.

The Community Health Care Trust employed staff with medical training from a variety of disciplines such as District Nurses and Physiotherapists. They visit patients in their homes and provide care to them there.

The Social Services Department employed staff with non­medical care skills also from a wide variety of disciplines such as Adult Carers and Child Protection Officers who also visit clients in their own homes and provide social care. The objective of both organisations was to enable people to go on living in their own homes for as long as possible, and thereby not to have to move into Care Homes run by the Trust.

This merger was a result of a new central government policy which was being piloted in the region in which Holland Rise falls. There are nine other Community Trusts within the region, none of which are so progressive in their thinking as Holland Rise. The objectives of the government policy are to improve the care provided and reduce the overall cost of providing that care. The new combined Trust was given a large degree of organizational and financial autonomy within the framework of overall management by the local region, and an energetic, forward thinking Chief Executive, John Jones, previously the Director of Social Services, was appointed to lead the new combined Trust. John Jones immediately appointed the hard­working Operations Director of the Community Health Care Trust, Dr Southgate to the position of Business Development Director – effectively his deputy.

The Trust is headquartered in an old Victorian Mental Health Hospital with 50 other offices, clinics and care homes scattered over the geographical area served by the Trust. Very few of these offices have been purpose built.

The Trust now employs 3000 staff split into a relatively small Head Office team including Finance, Personnel and Business Development and the professional care staff who are divided into 3 Directorates as follows:

· Adult Care

· Mental Health Care

· Child Care Services.

Each Directorate is in turn divided into 24 professional care disciplines such as District Nursing, Physiotherapy and Child Immunization. Each professional care discipline is, in turn, divided into up to 5 teams spread over the area covered by Holland Rise. There are in total 84 such teams each containing only specialists in the team’s particular discipline.

The care delivery process

The Trust is one of the 39 totally separate organisations which deliver care to the geographic area of Holland Rise. The other organisations are:

· 3 separate Hospital Trusts who each provide Accident & Emergency services, maternity services and a full range of clinical services to carry out operations on patients as required.

· 35 Doctor Practices (Clinics) containing a total of 60 doctors. These Practices are all contracted independently to the National Health Service and run effectively as individual small businesses that are paid by the National Health Service depending on how many patients are registered with them. The 35 Practices have formed themselves into a local group to meet regularly and discuss local problems, particularly the problems they have in dealing with Holland Rise Trust and the three separate Hospital Trusts.

People in need of care are referred to the Trust from a range of sources, for example the doctors, the hospitals, police, schools, neighbours and next-of-kin. The referrals contain wide disparities in quality and quantity of information and are normally directed to a local Trust office which may not house the professional care team who should deal with the particular problem so the referral is then referred on within the Trust finally reaching the correct team who take action. Referrals are received on a 7×24 hour basis and are actioned immediately if they appear to be very urgent.

The key actions following receipt of the referral are typically:

· A visit to the referred person in need of care by a senior care professional from the apparently most relevant care team, who carries out an assessment of the patient and may generate referrals to other teams within the Trust for their follow-up.

· Creation of a hand­written care plan. Some care plans are very complicated and some very simple. For example the Child Protection teams draw up very complex plans to solve the domestic problems leading to abuse of the child whereas the Podiatry teams are only concerned with scheduling visits to cut elderly patients’ toenails.

· Sign­off of the costs of delivering the care by the Team Manager, or adjustment if too expensive.

· Delivery of the care services, which vary in duration from one hour to several years depending on the discipline and type of care.

· Review of progress and revision of the care plan as necessary.

Each professional care discipline has developed its own styles of assessment form and care plan to record information about the patient, and each uses its own medical and care jargon to describe the same condition. Although a patient may receive care services from several teams in parallel, each of which is delivering its own specialty – for example district nurses dressing leg ulcers or occupational therapists modifying the home environment – no attempt is made to co­ordinate the care delivery or exchange care plans between the teams so they may well turn up at the same patient’s house on the same day and at the same time and one will then have to re­schedule their visit.

The teams are traditionally suspicious of sharing patient related information in case they make patient diagnosis mistakes, and the mental health and child protection teams are particularly concerned about security of information about their patients and clients.

The IT systems

The main IT software systems used in the Trust are not integrated with each other and comprise:

· The legacy Social Care system, which is primarily concerned with providing a basis for analysing the type and source of referrals received by the individual social care teams and recording the type of care and cost of care delivered in response to the referral. No attempt is made to record the outcome of the care delivered and all notes made by the social workers are hand­written and filed locally.

· The legacy Health Care system which is primarily concerned with collecting details of the activities carried out by the health care workers so that mandatory statistical analyses can be forwarded to the Ministry of Health in central government.

· An effective email system linking all of the offices together as well as to the outside NHS world via the systems operated by the Regional Office.

· A financial management and payroll system.

The legacy systems are old and very user-unfriendly in look and feel, and staff activity data is entered by clerks located in the scattered offices and then used for statistical report generation by the central IT Department. None of the health and social care professionals ever make use of the information in these systems.

The network linking all of the offices together is the responsibility of the IT Team in the Regional Office. They have wider and deeper IT infrastructure skills than the Trust.

The project

Having merged the administration of the two Community Health and Social Care organisations into one central team, John Jones has decided that he now wants to make advances in the provision of more effective care to his client base.

He has enthusiastically led the Trust in active participation in several EU organized pan European matched funded R & D projects exploring the benefits of multi­disciplinary care teams based on patient-centred IT systems with composite care plans.

He now wishes to implement this strategy right across the Trust and has motivated many staff within the Trust with his vision of the future comprising teams of staff drawn from several disciplines developing an integrated care plan round the needs of their patient/client and working in an information sharing environment to achieve better co­ordination of care delivery and thereby hopefully faster recovery of the patient or at least a more comfortable supported existence at home. As always in healthcare, all staff within the Trust are already working to the limits of their available time. This project involves further changes to the organisation, ways of working and the provision of a comprehensive integrated IT system.

In one of the European projects, some good R & D work was done on a pilot project within the Trust by a successful, but small, niche software company, JADE MediTech Ltd. who specialize in Mental Healthcare IT systems. They are very keen to develop a software package for a much wider health and social care market and see this leading edge project to be an excellent opportunity to bypass existing Healthcare and Social Care software suppliers and establish a market lead.

Against the advice of the Regional Office’s IT Officer, John Jones has succeeded in obtaining approval from the Minister of Health in the Government to bypass normal procurement procedures and to create a fixed price contract containing stiff penalty clauses for late delivery with JADE MediTech Ltd., who tendered against a well-structured but high level (bullet point style) Requirements Specification written jointly by staff from the Trust and the Regional Office. The Regional IT Officer was concerned about the financial capacity of JADE MediTech Ltd. to develop such a large software package.

The Trust’s team involved in the Requirements Specification comprised the Trust’s IT Manager and IT Systems Manager and four managers seconded from the District Nursing, Occupational Therapy, Child Protection and Mental Social Work teams respectively who were chosen on the basis of their reputation for being innovative in their thinking and supportive of the overall multi­disciplinary team concept. The Requirements Specification Team Leader was a senior Systems Consultant, James Saunders, who was seconded from the Regional IT team for the purpose. The Requirements Specification comprised an overall vision of the future written by John Jones and up to two pages of bullet points for each Care Discipline identifying their particular process and information needs. An extract from the Requirements Specification is provided in the Appendix.

All of the Trust’s Directors are in agreement with John Jones’ vision of the future but have targets to meet in the short-term and huge organisations to run. No plans currently exist of how the care staff will be re-organized into the multi­disciplinary teams.

If the project is successful the Region intends to implement the same reorganization everywhere and the Minister of Health will take the same approach right across the country. Both the Region and the Ministry want to monitor progress.

Dr Southgate has been made responsible for driving the whole project and has recruited you as Project Manager reporting to her, to take day-to-day responsibility. The goals have been set by John Jones, the Regional Director and the Minister of Health of a full live pilot implementation starting in 2 years with completion of the whole project within 5 years. No detailed plans exist for how these goals might be achieved.

Appendix: Example page from the Holland Rise Requirements Specification

Ref

Function Name

Criteria

3

Production of Treatment/Care Plans

3.1

Access to Assessment information

The software will provide easy access to Assessment information and Assessment summaries both for individual staff members and, where appropriate, other members of the team.

3.2

Access to history

The software will provide access to historic Assessments and Treatment/Care Plans.

3.3

Access to all records

The software will provide seamless access to all the required records on the software irrespective of the discipline.

3.4

Links to Episode of Care

The software will automatically link the

Treatment/Care Plan to the appropriate Episode of Care.

3.5

Development of Uni and Multi disciplinary plans

The software will support the development of both ‘Uni’ and ‘Multi’ disciplinary Treatment/Care Plans.

3.6

Record goals and objectives

The software will record goals and objectives and allow for time scales and anticipated outcomes in coded form for subsequent analysis.

3.7

Review date assignment

The software will assist the User assigning review dates.

3.8

Highlight reviews

The software will automatically highlight imminent or late reviews.

3.9

Record of unsatisfied demand

The software will facilitate the recording of the reasons for unsatisfied demand.

3.10

Record reason for Care/Service

The software will record the primary reason for Care/Service delivery.

3.11

Library of standardised plans

The software will contain a library of standardised Treatment/Care/Service Plans which can be tailored to individual needs.

3.12

Updating plans

The software will allow the facility to update or add to Treatment/Care Plans and enable staff to record manually the date of any changes made.

The software will facilitate the production of updated Treatment/Care Plan based on earlier versions.

3.13

Correction of content

It will be possible to ‘correct’ the content of a Treatment/Care Plan.

STUDENT TASKS

You are the Project Manager, responsible to Doctor Southgate, with day-to-day responsibility for implementing the introduction of a new IT system for Holland Rise Health and Social Care Trust.

However, it is clear that there are issues within the Project which are going to require some deeper investigation and research.

In order to deal with these you are asked to produce a Research Proposal for Doctor Southgate which includes the following instructions and requirements from her:

A conceptualization of one major problem the new IT programme may face; a clear research question or hypothesis and research objectives; a research strategy which includes a description and justification for the proposed data collection, analysis and interpretation methods and commonly used statistical procedures.
In relation to the statistical elements of the first task, Doctor Southgate is interested to know :

(a) whether or not the Holland Rise IT system could be more widely used (as the government hopes). In this regard she wants to know whether the statistics gathered will be descriptive or inferential. A clear explanation of both of these types of statistics is needed.

(b) what statistical analysis would be used, how results would be interpreted and written up accurately and comprehensively.

A section which indicates that your research is grounded in theory and that you, as Project Manager, have engaged in critical thinking when reading and assessing research articles.
An indication of any further areas of the project which may require future and new research.

Because she is busy she asks you to limit the Research proposal to 2000 words and suggests a weighting of importance shown in the Table below.

Marking criteria and link to Learning Outcomes

Topic

Learning Outcome

Weighting and approximate words

Conceptualisation of problem; hypothesis/question and objectives; research strategy; data issues and statistical procedures (Requirement 1)

LO7

40%

800 words

Descriptive and inferential statistics – definitions, explanations with regard to the Holland Rise project (Requirement 2a)

LO8

10%

200 words

Data collection, analysis and interpretation issues (Requirement 2b)

LO11

20%

400 words

Critical thinking in examining research articles (Requirement 3)

LO10

20%

400 words

Determining a new research question (Requirement 4)