Working to Improve Health Outcomes & Reduce Inequalities for Homeless People

By Sher Kayani, Improvement Advisor

The Triple Aim project that aims to improve health outcomes and reduce inequalities for homeless people in the borough of Tower Hamlets is gaining momentum.

The team made up of psychologists, assistant psychologists, psychiatrists, and service users from ELFT in addition to the staff and residents of two complex needs hostels in Tower Hamlets are making their way through the Triple Aim sequence for improvement and are now at the stage where they can test change ideas they have developed alongside the hostels.

Their chosen population segment is: Homeless people with complex needs living in two single occupancy hostels in the Borough of Tower Hamlets.

Figure 1: Project team meeting in person

Back in 2018, the team found that single homeless people in the borough of Tower Hamlets were experiencing health inequalities and poor health outcomes compared to the rest of the population.  It is reported that homeless people have a life expectancy of 42 years for women and 44 years for men, a good 30-40 years less than people who have not been homeless.*

This focused their attention on improving the health outcomes for homeless people with complex needs living in single occupancy hostels in the borough of Tower Hamlets.

Once the team selected their population, the next step was to identify the needs and assets of those that are homeless in Tower Hamlets. One way in which you can explore the needs and assets within a population is through conducting a three-part data review. This includes looking at:

• Reviewing available data to identify overall patterns that impact the chosen population
• Engagement with care teams and professional providing care or supporting the population to understand their perspective on the chosen population’s greatest needs and assets
• Service user and citizen interviews and engagement to understand their experience and perspective; to understand what is important to them; the real-world challenges they face in managing their health and living situations, and what might help

As part of the three-part data review the team worked in partnership with the hostels in Tower Hamlets, holding interviews with many staff and residents from the hostels to identify the needs and assets of the population and to identify the opportunities to improve health outcomes.
The interviews revealed four areas of focus for the project in order to improve health outcomes and inequalities for the population, which include:

• Relationships – Both staff and residents spoke of the importance of positive and supportive relationships
• Hostel operations – Both staff and residents spoke of how the hostels are managed provide an opportunity for improvement
• Health & ability – Everyone said that the mental and physical health of residents is a key area for improvement
• Services outside of the Hostel – The final theme relates to access to services outside of the hostel

Please play the video below for more details of what was uncovered from the resident and staff interviews:

Since identifying the key themes and drivers to focus on for the project, the project team have continued to work with the hostels by running workshops with the staff to develop change ideas and other projects that might need to be initiated to see an improvement in health outcomes for this population.

At the workshops, the teams used Nominal Group Technique (NGT), an inclusive and structured method to develop multiple change ideas around each of the themes identified.

Figure 2: Team using Nominal Group Technique to generate and theme change ideas 

Once the teams developed their change ideas, they then went through a process called Multi-Voting. Multi-voting allows all participants that have been involved in the idea generation process to vote for their favourite change ideas. Participants in the multi-voting can be given anywhere between 3 to 5 votes to assign to their top ideas. Going through this process allows teams to prioritise what they want to work on first.

Figure 3: Multi-voting

Following the NGT and Multi-voting exercise the team were able to identify their priorities. At the end of the workshops, those attending drew up action plans for their top two change ideas. Across the two hostels, the top four ideas included:

1. Starting up joint activities for staff and residents to participate in
2. Have healthcare professionals and other specialists visiting the residents in the hostel
3. Create a directory of all the services available to residents
4. Start multi-professional handover meetings

Figure 4: Developing action plans

The next stage in the teams’ journey is to involve residents at the hostels in the generation of change ideas. Whilst also support teams to test their top change ideas or, for more complex ideas, support with setting up new projects. The team are also in the process of drawing up a programme level Triple Aim measurement plan to understand whether their project is having an impact, this will include measures relating to ‘experience of care’, ‘health outcome’ and ‘value’.

Stay tuned to hear about the progress of this project team and the impact they are having on the health outcomes of the homeless in Tower hamlets.