The Safer Provision And Care Excellence (SPACE) programme is an initiative from the West Midlands Patient Safety Collaborative (WMPSC). Working with 32 care homes across 2 Clinical Commissioning Groups, the aim is to improve patient safety by training staff in quality improvement techniques. Unusually the programme seeks to equip staff to identify and then address risks (such as falls, pressure sores etc.), rather than dictating which risks should be addressed. This broad remit makes evaluation challenging so CLAHRC WM are conducting a mixed-methods review of the programme to assess how effective the training has been, how it has been implemented, how it has changed attitudes to safety and what impact this has had on adverse events. Whilst it is still too early in the evaluative cycle to demonstrate changes to adverse events, it has already generated a positive attitude towards the programme and safety and qualitative evidence that it is having a demonstrable impact on safety. A recent Care Quality Commission inspection of community services in this area rated them as “outstanding”, specifically mentioning the SPACE programme: "Staff told us, and we saw, that pressure ulcer incidence within private nursing homes had decreased and increased numbers of people were able to die in their care home where they had staff who knew them, rather than in an acute hospital." (CQC Report, May 2017).
The positive benefits already identified mean there are plans to expand the programme to cover residential as well as nursing homes in Walsall and Wolverhampton
Contribution of CLAHRC WM
The approach adopted by the SPACE programme of empowering care home managers and staff to identify and address risk makes evaluation very challenging. Without CLAHRC’s regional reputation and expertise, the programme might not have been evaluated with the danger that any benefits might be lost and this might adversely affect future implementation of this or similar approaches. It was always anticipated that there would be a positive reaction from staff to the programme but this formal, independent evaluation should ensure that there is a strong and rigorous evidence base to support this work and so promote its future spread.
What happened next?
Year two of the evaluation is underway with one of the key aims being to improve the quality of data available on adverse incidents to allow a more accurate assessment of the effectiveness of the SPACE programme. The positive benefits already identified mean there are plans to expand the programme to cover residential as well as nursing homes in Walsall and Wolverhampton. There are initial discussions underway with WMPSC about a SPACE 2 programme to further develop the model and expand its reach, including discussions to incorporate it within the Black Country STP programme.