Keeping the A in AHSN

Lars Sundstrom, our Innovation and Growth Director reflects on the role of academia in encouraging innovation and experimentation, and the importance of this to AHSNs.

Last month we had our first get together as an AHSN Network. Around 200 fellow AHSNers, most of them considerably younger and much more energetic than me, got together to celebrate how fast and far we have come in our first five years. Bright eyed, bushy tailed and ready for the next challenge, how can an old-timer like me not be inspired by the next generation and their appetite for the future?

When I was a university professor, I always felt the best antidote to feeling blue or if things got a bit bogged down was to find some students and talk to them. You quickly realised that the world is driven by hope and belief in the art of the possible, but that over the years you accumulate fear and restraint to the extent that you focus more on the art of the impossible.

Anyway, at the AHSN gathering I felt like a milestone had been achieved, not just because we entered another five year licence, but because it completes a personal journey from invention to innovation that I have been on for the past 30 or so years.

Bench to bedside

As you have probably guessed, the path that led me into the AHSN was not via the NHS but through academia. I spent most of my career in translational medicine doing drug discovery and development both in universities and in industry. I tell the youngsters in the team that back in them olden days when I was young we didn’t have a word for translational medicine, and we didn’t even know how to do it. I tell them we didn’t have phase one, phase two and phase three clinical trials; we just gave people pills or injected them with stuff and saw what happened.

“No way man – how could you do something like that? That can’t have been safe!” Well it wasn’t, I say, but what else could we do? Somebody had to be brave enough to be the first!

Translational medicine was the buzz word at that time and the term ‘bench to bedside’ is often used to describe it. So what brought me to the AHSN was the next logical phase – to  scale up. Perhaps we could say bedside to bedsides. I was also attracted by a new buzz word ‘innovation’, which I believe is probably the most important word to ever impact the NHS, and I’ll explain why shortly.

So back to the AHSN conference. After reminding people how AHSNs came into being five or six years ago, the speaker asked, “Hands up how many of you were around when it all started?” Apart from me, a few hands went up. She described the amazing progress made and we looked into the future and it felt great – except a bit of me felt that as the endeavour grows, that original pioneering spirit of adventure was slowly slipping away a little; that leap into the dark, that fear of the unknown. It all felt a little too safe, a bit too much like the NHS.

In the coffee break I bumped into my colleague and friend Tony. “What did you think of that then?” I asked. “It was great”, he said, “but I guess I’m still trying to figure out when it was that I joined the NHS?” “Yeah,” I said, “it feels a bit more like we’re in the NHSN rather than the AHSN.”

The conference concluded with a fabulous talk by Michael Seres, a patient entrepreneur and someone I have admired for many years. We once ran a conference on what it’s like to be an entrepreneur and inventor developing products for your own health issues – a ‘chief patient officer’ as Michael describes it. His message to us was clear: “Dare to be brave.” What’s  great about people who have come to this journey by misfortune in life is their spirit of adventure. It feels like they have nothing to lose and everything to gain, so they just hurl themselves into the unknown with unswerving devotion and energy.

People like Michael, Kevin Mashford, David Constantine are amazing – people who dare to be brave and innovate against all odds are the ones who will change the world.

What is innovation?

So back to innovation, this new buzz word. What is it? Well, like translational medicine in the olden days, we actually don’t really know how to do it healthcare. In 10-20 years’ time I will be able to tell you. I can tell you what it isn’t though. It isn’t about continuous improvement; it is about doing something that hasn’t been done before. Therefore it is also not 100% safe. I could write a blog on just that but in the meantime have a look at this excellent blog post by Alex Ryan and Jerry Koh on the subject.

I strongly believe, as I have said many times before, without innovation the NHS will not transform and will not be sustainable and it won’t survive. But like translational medicine back in the day, if we don’t try and we don’t fail, we will never learn and it will never be safe. So my message to the young AHSNers is: dare to be brave, learn from failures and then improve it, and it will become safe.

In the questions and answer section, I asked the chief officers where they would like us to be in five years’ time. Charlie Davie, Managing Director of UCL Partners, gave a great answer. He said, “I want the NHS to be known for being the best place in the world to do innovation, and in future the Americans come over here to learn, instead of us going over there to learn how to do improvement.”

As an academic, I know that all improvement and impact starts with experimentation. So I say, let’s keep the A in AHSN – where it stands for Adventurous, Ambitious and Audacious. If we see ourselves just as a safe distribution channel for innovation into the NHS we will have become NHSNs, and from there it is a small step to becoming the NHS and we will have failed to change anything.

So let’s dare to be brave, keep the academic mentality in the AHSN, and keep in mind the words of George Bernard Shaw:

“There are those that look at things the way they are, and ask why? I dream of things that never were, and ask why not?”

The Usual Suspects: ways to widen involvement in service improvement

Hildegard Dumper, West of England AHSN PPI Manager, reflects on ways to widen involvement and participation in service improvement.

This story is a composite drawn from real events with names and identifiable features changed.

Pamela came out of the COPD Steering Group meeting the other day feeling really upset, and determined to leave the project. One of the clinicians on the steering group had asked about increasing the number of public contributors on the group. He said that there was a need to make sure patient reps were more diverse and we needed to avoid ‘the usual suspects’. By this he indicated he meant ‘white, middle-aged and retired’ which of course is what Pamela is. Debbie, the project manager noticed she looked upset and asked her what was troubling her. When Pamela told her, Debbie tried to reassure her that she was still a valued member of the group.

However, the experience got Pamela thinking. She approached Debbie and asked her if she was willing for Pamela to look into this. They agreed that Pamela would draw up a plan for how they could engage with a more diverse group of people suffering from COPD. She would share it with Debbie and take this on in a voluntary capacity, claiming for expenses. The plan included the need to have a discussion with the advisory group about what was meant by being representative – the demographics of the population of the area served, or users of the services. Or was it just different voices they needed round the table. In which case they could promote the role amongst users of the service and encourage interested people to apply. It was felt that all three factors were of importance.

Drawing on information from public health, it was identified that COPD was something that affected the population they served in different ways. Communities from a number of different ethnic and socio-economic backgrounds were heavy smokers and at risk of COPD. Pamela identified visiting three different communities in the region that reflected this range (Somali, Polish, deprived white). She contacted someone who Debbie knew in public health and got the names of the health ambassadors (in different regions they are known by different names) who had contact with these different communities.

She contacted them and it was suggested she attended one of the team meetings that were held monthly. She could then explain to the team what she was trying to do and get their advice. The public heath ambassadors were very encouraging, but pointed out that the communities she was targeting were mainly people who were struggling with their own challenges related to language, surviving in a different culture and the day to day challenges of living with poverty. It would be difficult to find people with the practical wherewithal and emotional space to contribute what was needed at a strategic level to the development of a project. However, they told her about a number of community events and encouraged her to attend so that she could meet people and identify people who may be interested.

Some months later, Pamela went back to Debbie with a three point proposal. She suggested that an extra patient rep be identified from users of the service interested in becoming a member of the steering group. Having two lay reps is seen as good practice as it takes the pressure off one person having to speak for all lay people, and offers a different viewpoints being heard. Pamela has also got to know the health ambassadors. One of them has shown a particular interest in the service and has good access to inner city communities. Pamela suggests inviting her to be part of the steering group so she can act as a conduit to some of the affected communities. Lastly, Pamela suggests they run a series of road shows where members of the steering group attend local community events to talk to those attending about the service and how it can be improved. This would require a big time commitment which may not see any immediate impact, but would be the start of forming a relationship with the communities they want to reach.

It was a learning experience for all involved.

  • For the clinicians in the steering group, they realised that different methods were needed to communicate with different groups of people.
  • Another key point was that it takes time to build up the relationships needed to identify the right people.
  • For the health ambassadors, they appreciated the direct link with clinicians and the relationships that developed as a result.
  • The experience also enhanced their knowledge and understanding of the pressures on the services helping them to manage the expectations of the communities they worked with.
  • The communities valued the fact that people were listening to them and wanting to understand their experiences
  • They themselves had a deeper understanding of how things worked and were able to have a more realistic expectation of health services and their role in managing their condition

 

The answers are out there

Natasha Swinscoe, Interim Managing Director, explores some of the issues raised by the recent Nuffield Trust  paper ‘Falling Short: why the NHS is still struggling to make the most of new innovations’.

Many of the NHS staff I’ve worked with seem to be cut from the same piece of cloth. If you show them a problem needing a solution, they’ll either find the solution or work out how to. These people are proactive problem solvers, so if the thing they need isn’t on the market, they may well make one ‘Heath Robinson’ style.

At a recent conference I listened to clinicians from one of our local trusts outline some of the systems and solutions they’d been putting into practice to fix their problems. These ranged from different training methods to a sponge being used in an innovative way to stem internal bleeding. I was struck by their creativity and innovation. The question in my head was how we harness this creativity, recognise and celebrate it, and then spread the solutions to others in different hospitals to use. Professional networks often provide an adoption route, but even these don’t offer comprehensive coverage.

Shortly afterwards I read the Nuffield Trust briefing paper ‘Falling Short: why the NHS is still struggling to make the most of new innovations’. I knew it resonated with my experience when I kept underlining sentences in red, with a number of exclamation marks! Here are a few…

  • Innovation in the NHS relies on pushing products first and hoping people take them up!
  • Identifying problems and looking for solutions isn’t built into everyone’s day job!
  • Innovation needs Senior Exec level oversight and support!
  • Too often short term savings drive the need for innovation rather than transforming pathways!

These are all important points. We know clinical and non-clinical staff will always find solutions. What we can’t rely on is the culture within the NHS supporting innovation. If the culture doesn’t foster or support innovation then new solutions or ways of working will falter, stay hidden from others, or at worst fail to solve the problem.  A ‘let’s try’ environment is crucial.

In my role as a manager of Acute Services, I lost count of the number of times I had clinicians turn up at my door or stop me in the corridor with an ‘idea’ they wanted to try – frequently for little or no cost.  We often pursued these ideas with a positive ‘Ok, let’s give it a go’.  Out of this came some fascinating service and pathway changes benefiting patients and staff, and saving time or money that we could then re-invest.  There were many  win-win results,  but they relied on a team culture that encouraged and shared  ideas, kicked them around, and then had a go, without being sure if they’d be successful or not.

From April we’ll be working with Office for Life Sciences to support this innovation pathway ‘end to end process’. We will be looking for ways to strengthen and support trusts and commissioners to adopt tried and tested ‘oven ready’ innovations. We will be looking for ways to capture ideas from front line NHS staff to match with business sector innovators.

The answers are out there. The people working in the NHS every day, the ones facing the situations that need solving, embody a wealth of creativity. We should be asking them what they need to make their working lives easier, what they need to make services slicker, safer and cheaper. They know what’s needed. If we support them and pair them with innovators and creators in the commercial and business sector they will create the changes we need. Let’s all start by looking for our innovators, listening to them, and supporting them to give it a go.