Case study – Small changes lead to big improvements at Auchtermairnie: March 2026
Small changes add up and make a big difference, without taking a huge amount of work.
Auchtermairnie care home has seen improvements in important areas such as resident experience, falls, resident weight and sleep quality. The team achieved this by making small changes and fostering an improvement culture. This was achieved by creating new lines of communication with care home residents, maintaining curiosity to follow what works and shed assumptions, as well as prioritising staff inclusion at every stage of change.
Situation
Before taking part in the Reducing Stress and Distress Improvement Programme, the team at Auchtermairnie were seeing little use of the communal lounge area by residents in the evenings. The evenings were also periods of increased stress and distress for residents, and the most likely time for falls. The team joined the programme with an aim of improving evening experiences for residents.
Approach
The team initially assumed that noise in the lounge may have been bothering residents and set out to gather information using a novel approach: the manager of the home would live as a resident for two days, and converse with other residents as a peer. The experience proved very fruitful for the team’s improvement work with information gathered through observation and through conversation. A major piece of learning was how much residents enjoyed speaking with a member of staff who was not focused on a task, and how this encouraged residents to stay in the lounge area. The team arranged to have a staff member stay in the lounge each evening thereafter with the aim of having conversation and engaging in meaningful activities with residents. This staff presence kept lines of communication open and allowed the team to implement lots of small changes and get immediate feedback on them.
After the initial testing, a check-in with all staff was set up to discuss learning and consider next steps. These check-ins became a regular part of working as small changes were being implemented, and this ensured that staff felt included and part of decision making. This was a factor in changes being successful as they were planned to suit everyone – residents and staff.
Results
A lot was learned through the new way of evening working, and it supported many small changes in the communal lounge area. A significant change was the presence of a member of staff in the lounge. This not only enabled opportunities for conversation but also for a range of activities to be introduced for residents to participate in. Another small change was bringing a tea trolley into the lounge. This has improved consumption of drinks and snacks in the evening with impact being evidenced through weight gain for several residents.
The team also looked at the environment after learning that their initial assumption about noise was incorrect – the residents didn’t mind any of the noises in the evening. They did have issue with the lights, and the team set about changing the intensity of the bulbs. They also had issue with the temperature, which they staff were able to adjust.
These changes led to an increase in number of residents using the lounge each evening: 6-10 residents each evening. Residents report feeling safer and happier when staff are present. An improvement in sleep patterns has been evident for several residents e.g. one gentleman no longer asks to retire to his bed after tea but prefers to remain in the lounge area until after supper
There’s been a reduction in walking with intent from some residents who now prefer to engage in socialising and activities in the lounge. Staff are also able to prompt residents to use their walking aids and these two factors have led to a reduction in falls within the care home.
Key learning
The changes at Auchtermairnie are very positive, and it was no single thing that made the difference. A series of small changes, and new ways of working, created the conditions for things to improve sustainably.
Staff assumptions were shown to be incorrect on several occasions, and it has been essential to involve and meaningfully engage with residents to ensure any changes meet their needs. An example of this was when activities were introduced to the lounge in the evening. Staff initially expected residents may prefer relaxing activities like hand massages but instead found that residents were keen for interactive and competitive games like cards and dominoes. Staff were able to be adaptable and responsive to this feedback, ensuring activities were well received and engaged with.
The residents responded very positively to having a staff member in the lounge, both for providing company, and a line of communication to share their views. They were able to feel more agency over their environment and community. Staff are now reporting that by spending more time in the lounge, residents have formed friendships with each other and there is less demand for staff conversation.
The changes have also made a difference to staff, who have felt included at every stage and have given positive feedback on the process and new culture of improvement in their workplace. There was some initial resistance to having a staff member in the lounge, as this person would be moved from elsewhere in the home and there were concerns about impact on workload. Having data to evidence the impact of the changes has supported better buy-in with staff who can clearly see the value for residents.
The team have also recognised the importance of continuing to collect data to monitor impact of any changes. During winter pressures, there were too few staff to have one in the lounge in the evening. During this 4-week period, only 2-3 residents spent time in the lounge each evening, and there were four falls. By using this data, the team were able to prioritize reintroducing a staff member to the lounge. Attendance at the lounge returned to 6-10 residents each evening and there have only been two falls in the two months since, and none in the evenings.
Next steps
The success of Auchtermairnie shows the difference that can be made through a series of small changes and fostering an improvement culture. Novel approaches for gathering information can lead to new ways of working. The approaches taken by the team at Auchtermairnie were underpinned by respect for residents and staff members alike. The team made sure to allow for perspectives to be gathered and considered before deciding next steps and checked in regularly about how any changes were going. This method can be applied to any setting. Small changes like improving the temperature or lighting can be part of paving a way to a reduction in falls, improved sleep and diet, and reduction in stress and distress.