Kisharon is a charity that supports adults with learning disabilities in supported living and day opportunities. Their aim is to enable everyone to reach their potential in as many different aspects of life as possible. Support is given with activities of daily living, finding work opportunities, living and travelling independently and healthy lifestyle choices. Kisharon provides an individualised service which is person-centred and supports people to make choices about their own lives. It is an extremely well run, very focused organisation constantly looking for ways to improve and develop.
I spoke to Bev Jacobson, CEO of Kisharon, last spring to ask her whether she was interested in hearing about our app, Infinity.
Infinity is a secure collaboration and task management tool created to allow care teams to share information about the people they look after and communicate with each other at all times from where ever they are. Poor communication at handover accounts for one third of all patient safety incidents and the paper-based processes currently being used are contributing to reduced time to care and increasing costs. Our goal is to improve safety and efficiency in health and social care settings.
We have developed Infinity with significant input from carers and healthcare professionals to ensure that it is user friendly and relevant. We strongly disagree with IT software being imposed on the care and health sector.
Bev Jacobson introduced me to Julia Brown, Director of Operations and Development, and Necola Reid-Warner, Supported Living Operations Manager, to discuss the existing processes and their challenges, at Kisharon.
Kisharon have 11 residential sites in adult supported living and two sites with day opportunities.
At Infinity Health, we initially spend time carefully listening to the current situation regarding sharing information and handover, and ensure we fully understand the challenges and a clear definition of success.
To achieve this, I spent time with Necola Reid-Warner and other managers, learning about the structure and ethos of Kisharon and then sitting down with the support workers to hear about their work and experiences directly from them.
Handover meetings occurred at the beginning and end of each shift where outgoing staff would update incoming staff with any changes, incidents, concerns and decisions. These details would be written in individual folders, the communication book and appointment book, all stored in offices.
Managers accessed these details either by visiting the sites and having face to face meetings with the staff or by reading the documentation, or by calling staff.
From the interviews and surveys, we were impressed by the dedication of staff. Each individual has a detailed personalised care plan which is handwritten and kept in an office. Support workers spent a lot of time writing in multiple places, realising the importance of good handover and comprehensive notes.
The challenge that this produced was that it required time away from the people they support, often they returned from activities early to make sure all details were written down. Inevitably, sometimes this was rushed and could result in inaccurate and illegible records.
The handover meetings were at fixed times and places, when tasks were waiting to be completed and interruptions were inevitable. If inadequate handover resulted, then shifts started with incomplete information.
An important aspect of the work that Kisharon does is to accompany individuals to many places, including day opportunities, appointments, work placements, shopping and the gym. As they spend most of their working hours away from the residence, it is hard to remember all the points to write down on their return and there is obviously a delay in sharing information with the team.
Many tasks at Kisharon recur daily, for example personal hygiene, assistance with dressing, preparation of food and so on. Documenting all this in folders in the office, to demonstrate that tasks had been completed, is time consuming.
Managers reported that they spent time calling and chasing busy staff to obtain information or reassurance that jobs had been done. Families also called to leave information or ask questions- again increasing workload to already stretched support workers.
Staff said that they needed to share information at least five times a day with others - for example, with managers, family members, social workers and other healthcare professionals.
Many expressed concerns regarding the efficiency of the system, admitting that it was frustrating and sometimes could affect safety of the individuals.
We ran a pilot study in one adult supported living site, with support staff and managers using Infinity. This enabled the whole team to add notes and tasks as required during their working hours, edit the status of tasks and all have continuous visibility of activities in real time.
To our surprise, over two thousand tasks were created and completed over three weeks, highlighting the heavy workload level and documentation challenges.
We learnt several crucial points from the pilot and developed new features in Infinity as a result.
Firstly, it was very pleasing to see all care staff use Infinity with minimal guidance and ease, even if they did not personally possess a smart phone.
The response was very positive with support workers willingly using Infinity for their everyday work and feeling connected at all times with the rest of their team.
The care plan was ‘brought to life’ by the team having continual access to the care plan as opposed to it just existing as a document in a drawer.
Managers felt liberated by not having to travel to read reports and repeatedly calling staff to request updates on activities and jobs. This facilitated a slightly different relationship between management and frontline staff, allowing the team to focus on other issues.
One new feature that we developed in response to feedback and observation was ‘Comments’ - a way for the team to communicate with each other about each particular individual from where ever they were. This in effect has replaced the Communications Book (a handwritten record of all communication relating to the individuals they care for) and has the added advantage of being updated in real time at the point of care, immediately visible by the whole team.
We also explored a systematic way to record and manage the large number of recurrent tasks which was the mainstay of support at Kisharon.
Interestingly, Kisharon underwent a CQC visit during the pilot. Staff reported how they proudly showed Infinity to the inspector and explained their new way of working.
Consequently, use of Infinity was adopted by Kisharon throughout adult supported living and is currently being rolled out into day opportunities.
I would like to share comments from managers:
Fola: “It is amazing, once all the information has been uploaded, I can view it from anywhere, and everyone is informed at all times. Where there are 9 people we support in one site, support workers don’t have to look through 9 folders”
Natalie: “Infinity reduces duplication, it’s so easy to use”
Micki: “It is so simple and easy to use, staff find it very easy”
Petrona: “Staff have more time to spend with the people they support”
Necola: “Staff are motivated to use Infinity, I have noticed a big reduction in phone calls. Staff are confident using Infinity and support each other, there’s been an increase in ‘team feeling’. I have a good sense of what is happening on a daily basis, without looking in the files”
We have many exciting next steps involving developing features in Infinity that have emerged from discussions and learning whilst working with Kisharon.
Julia Brown, Director of Operations and Development: ”We are keen to involve families and wider support networks including primary care. Currently families visit, call or email staff regularly to ask questions, discuss health and other information and learn about targets achieved. Using digital technology to share timely information and achievements with key people, will add significant value to the care we provide and reduce pressure on support staff and health and social care services”.
Dr Jo Garland