Transforming Care - Implementing the Roadmap
Supporting the development of staff and residents.
Themes: Maintaining Identity & Improving Health and Wellbeing
Cohorts 23, 25, 26 and 28
Aim of the project
The aim of this quality improvement project was for care home leaders to implement the ‘Meaningful Connection Roadmap’ into their respective care home setting and increase the evidence-base of the practicalities of its implementation.
Who was involved
Residents, relatives, staff, Public Health Agency, and Patient and Client Council
My Home Life Tools and Resources used
My Home Life Integrated QI methodology model, Frameworks, Image cards, Emotional touchpoints and Magic wand.
Quality Improvement Projects
Implementation of the Roadmap differed by leaders' interpretation of the needs of the care setting. Several quality improvement projects that Enhance Meaningful Connection are shared below (Table 1):
Table 1: Summary of ‘Enhancing Meaningful Connection’ Roadmap in various care settings
Nursing Home
Celebrate resident individuality to improve resident mood and wellbeing and enhance staff morale within the care home setting. | Dementia Care Unit
Opportunities for meaningful connection during personal care routines and mealtimes that enhance these everyday interactions and strengthen relationships with residents. |
Nursing Home Implementing Life Story Work to reduce ‘Trust’ reportable incidents of behaviours that challenge for residents needing enhanced supervision care (1:1). | Residential Setting - Learning Disability Empower residents to influence activity planning by using the visual Roadmap to support communication and engagement.
|
Nursing Home
Improve meaningful connections with residents nursed in bed who are often at greater risk of isolation and reduced stimulation moving away from task-orientated care towards care that is relational, curious and empathetic.
| Residential Setting - Learning Disability Develop a group forum for residents to enhance opportunities for meaningful connection. |
Nursing Home Using Life Story Work to build meaningful connection and reduce the number of falls new residents may experience as they navigate their new home in the first 49 hrs. |
Support staff to build relationships with residents and celebrate resident individuality.
Aim: To improve resident mood and wellbeing and enhance staff morale within the care home setting.
Quality Improvement Project
- Improve communication with relatives
- More inclusive, person-centred approach
- Enhance resident care, communication, safety, and emotional wellbeing
Outcomes: Residents more settled and engaged. Staff spent more time with residents through meaningful activities. Greater supervision and awareness of resident needs.
Staff less task-driven; more present and engaged Residents feel supported, understood, and more settled. Embedding of person-centred care. Calmer and more supportive home environment. Reduction in falls (Table 1) and PRN medication (Table 2).
| Table 1 | |||||
Month | March | April | May | June | July |
Number of falls | 4 | 4 | 1 | 0 | 0 |
| Table 2 | |||||
Month | March | April | May | June | July |
Number of days of PRN Diazepam usage | 8 | 12 | 9 | 1 | 1 |
Create opportunities of meaningful connection within a dementia care unit, during personal care routines and mealtime experiences.
Aim
To create meaningful connection in everyday interactions with residents.
Quality Improvement Project: Staff spending more quality time engaging with residents. Significant improvements in social interaction at mealtimes
Outcomes
- Mealtimes now positive, sociable, and supportive. Improved staff morale and teamwork (Table 1)
- Stronger leadership embedding a person-centred culture
- Audits show positive trends (falls, PRN, dining, activities)
Type of Unit | Previous attendance during mealtimes | Current attendance during mealtimes |
Dementia Unit (13 residents in total) | 1-2 residents | 5-6 residents |
Rehab Unit (15 residents in total) | 2-3 residents |
|
Life Story Work to reduce ‘Trust’ reportable incidents for residents needing enhanced supervision care (1:1).
Aim
To reduce Trust reportable incidents of behaviours that challenge for residents needing enhanced supervision care (1:1) through Life Story Work.
Interventions
- Improve staff access to Life Story Work booklets by moving them from nurses files to the carers files
- Include residents life stories in the handover process would help staff learn about each individual resident
Outcomes
A staff survey reported - 97.6% of staff strongly agree that Life Story Work has helped improve person centred care. There was a decline in trust reportable incidents. Reduction in falls (Table 1)
Month | January | February | March | April | May |
|---|---|---|---|---|---|
Trust reportable incidents | 3 | 3 | 1 | 0 | 0 |
Staff said,
“Life story work helps gain powerful ways to deliver person-centred care which turns tasks into real relationships.”
“I use their past hobbies, career and family history as conversation starters. This helps validate their identity and tailor communication to topics that bring them comfort and joy.”
“I can confidently give person centred care instead of using the same approach for everyone.”
Using a visual Roadmap to support communication and engagement
Aim
Use the visual Roadmap to support resident communication and engagement in individualised activities, and develop a resident group forum.
Quality Improvement Project: Encourage greater participation and a sense of independence, purpose, achievement through meaningful activity.
Outcomes
- Residents were engaged in a wide range of personalised activities, including horse riding, swimming, visiting loved ones graves, shopping or attending the bank
- Improved sleep routine, reduced behaviours that challenge and reduced prn medication
- Overall morale and mood improved
- Relationships with family, other residents, and staff members improved
Meaningful Connections for residents nursed in bed
Aim
The Roadmap would support and train staff to recognise the importance of the social and emotional wellbeing of residents, alongside their physical health, and move away from task-orientated care towards care that is relational, curious and empathetic.
Quality Improvement Project
Encourage staff to be more present in the moment and spend meaningful quality time ‘with’ residents – e.g. hand massages, manicures, reminiscence, watching TV Programmes or simply having someone sit and chat with them.
- Involve the whole team, not just nurses and carers.
Outcomes: Baseline findings found positive interactions were already taking place, however during busy periods engagement could sometimes become more task-focused. Residents nursed in bed appeared calmer, happier, and more responsive. There was increased engagement in conversations and more natural interactions happening throughout the home.
Resident said,
"I enjoy having someone sit with me and talk. It makes the day go quicker."
Family said,
"It's lovely to see Mum smiling and chatting more when we visit."
Staff said,
"Sometimes the smallest interactions make the biggest difference."
Develop a resident group forum
Aim
Co-create a resident group forum where residetns could come together, socialise and have a safe place to check in on a weekly basis.
Quality Improvement Project
Residents forum would build individual capacity and peer support within the home.
Outcomes
- Residents enjoyed space to share their opinions and be open with others. They Gained a deeper understanding of their own and others emotions. Shared skills and learned from each other through peer support
- Residents gained improved communication skills, more conversations happened between residents and residents experienced less episodes of distress
- Relationships between residents and staff improved - less behaviours that challenged.
- Improved overall morale and mood.
Resident said,
“ I like the check-in, I get to hear what everybody is feeling... I need to start saying what is really wrong”.
“It feels good to know how others are and that we all have something going on”.
Using Life Story Work to reduce falls for new residents in the first 48hrs after admission
Aim
To minimise new resident falls in the first the 48 hours of admission using Life Story Work.
Quality Improvement Project
- Issue life story booklets to families at pre-admission so personalised information is available when at resident admission
- Share new resident information at handovers and safety huddles
- Improve staff access to Life Story Work not just to the activity leader, but to all staff
Outcomes
- During March to May the care setting recorded no new resident falls.
- One new admission settled quickly into care home.
- Relatives feedback was positive, and staff were able to understand and connect more quickly with the resident.
- The monthly falls declined overall between March to May which may be attributed to increased focus on meaningful connections in general. (Table 1)
Month | February | March | April | May |
|---|---|---|---|---|
New resident falls | 3 | 0 | 0 | 0 |
General falls in care home | 11 | 8 | 3 | 3 |
Overall, the implementation of the Roadmap had a positive impact across the participating care settings. The quality of care improved, with a greater emphasis on residents' social and emotional wellbeing alongside their physical health. Preventive care also showed positive outcomes, including improvements in falls data and a reduction in PRN medication use.
Residents were empowered through the use of the visual Roadmap, which enhanced inclusivity by providing a clear visual aid. Residents also had greater influence over the selection of activities, promoting a more person-centred approach.
Interpersonal relationships were strengthened, with improved communication between care settings and families, as well as increased resident participation in social activities.
The Roadmap also contributed to a more positive culture within care home settings. Staff morale improved, and one care setting reported reduced reliance on agency staff, which was attributed to lower levels of staff sickness. In addition, external stakeholders, including the RQIA, recognised the positive changes in the culture of meaningful connection during their inspection of the care home.
RQIA report “The importance of engaging with residents was well understood by the manager and staff (...) Staff understood meaningful activity was not isolated to planned social events or games (...) Residents were looking forward to planned events (...) Staff were observed sitting with residents engaging in discussion” [April 2025]
Key learning
The embedding of meaningful connection in care home settings created some initial challenges although developed sustained and consistent improvements in clinical and relational care. A challenge acknowledged early by participants on the My Home Life Programme was the time it takes to recognise the social, emotional, physical, and systemic impact of implementing a meaningful connection culture. That needs careful reflection in the beginning.
The ‘Enhancing Meaningful Connection’ Roadmap supported both improved care for residents, and a stable workforce delivering care that is consistent, safe, responsive, and well-led. As key advocates for some of the most vulnerable in society it is important to utilise meaningful connection approaches to help prevent complex cases from falling through the gaps.
Upholding these connections should be a central focus for care providers, regulators, and wider society. With a greater focus on meaningful relational care, the culture in care home settings became less task-driven, and staff became more present and engaged.
